LIBRARY OF CONGRESS, 



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UNITED STATES OF AMERICA. 



HYGIENE OP CHILDHOOD 



SUGGESTIONS FOR THE CARE OP CHILDREN 

AFTER THE PERIOD OF INFANCY TO 

THE COMPLETION OP PUBERTY 



FKANCIS H. KANKIN, M. D. 

PRESIDENT OF THE NEWPORT MEDICAL SOCIETY, 

MEMBER OF THE NEWPORT BOARD OF HEALTH, 

FELLOW OF THE RHODE ISLAND MEDICAL SOCIETT, ETC. 




NEW YORK 
D. APPLETON AND COMPANY 

1890 



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v° 



CoPYKIGHT, 1890, 

By D. APPLETON AND COMPANY. 



®o t\)c fficmoro of mg IHottycr 

LAURA WOLCOTT RANKIN, 

THIS LITTLE VOLUME IS REVERENTLY DEDICATED 

A3 A FILIAL TRIBUTE OF ADMIRATION FOR HER 

MANY YEARS OF EARNEST PHILANTHROPIC EFFORTS 

TO ELEVATE THE 

MORAL AND PHYSICAL WELL-BEING 

OF TnE YOUNG. 



PREFACE 



The strength and prosperity of a community 
and a nation are largely influenced by the sturdy 
vigor of body and mind of the adult population ; 
and, as the oft-quoted saying that the child is father 
to the man is true, and as the vigor at maturity must 
in a great measure depend upon proper guidance 
during the years of development, it follows that it 
is of the utmost importance that parents should have 
correct ideas on the personal hygiene and care of 
their children. 

Notwithstanding that the study of the period of 
infancy and adolescence has received especial atten- 
tion of late years, and that mothers are realizing more 
and more the vital necessity of hygienic observ- 
ances at this time of life, the physician in his round 
of visits is made aware of a woful lack of knowl- 
edge, or perhaps appreciation, of the laws of health 
by mothers and by others who have the guidance of 
youth; and he feels that arguments demonstrating 
the necessity of closely studying the requirements 
of childhood can not be too frequently presented. 



6 PREFACE. 

This little manual, on the care of children from 
the period of infancy to the completion of puberty, 
can not naturally be considered as embracing the 
entire question of the hygiene of childhood, but is 
intended merely to awaken serious thoughts in the 
mind of the mother relating to the care of her chil- 
dren ; and it is hoped that the suggestions herein 
contained will afford practical aid, and enable her 
to avoid numerous hygienic sins of omission and 
commission. 

Newport, R. I. 



CONTENTS. 



PAGE 

Preface 5 

Introduction 11 

Death-rate of children and observance of the laws of health. — 
Low mortality among Indian children. — Deductions from 
Indian habits of life.— Result of proper and improper 
guidance during early childhood. — Moral training. — Regu- 
larity of habits a necessity for perfect health. 
Dietary during Childhood 18 

Material for healthy development.— Simplicity of food. — Over- 
taxing the digestive organs. — Purposes for which food is 
taken. — Importance of a due amount of carbonaceous and 
nitrogenous elements and of mineral salts. — Necessity of 
variety of food. — Consideration of milk, cereals, oatmeal, 
sweets, eggs, and meat. — Natural craving for acid fruit. — 
Articles of diet. — Indigestible food, pastry, spices, tea, 
coffee, etc. — Abundance of food during school -days. — 
Regularity of meals and eating without hurry. — Effects fol- 
lowing errors in diet. — Fatigue affecting the appetite. — 
School lunch. — Indigestion inducing catarrh of the upper 
air-passages. — Children following their own fancies in eat- 
ing. — Educating the appetite. — Evil results of misguidance 
in dietary. 
Protection of the Body 39 

Physiological action of cold. — Standard heat of the body. — 
Animal heat. — Nerve-force exhausted, and excretory glands 
of the skin affected by cold. — Harmf ulness of short socks. 
— Dressing for effect. — Woolen and linen underclothing. — 
Our changeable climate. — Benefits of ample protection, 



8 CONTENTS. 

PAGE 

and dangers of scanty clothing. — Protection of feet and 
legs. — Draughts. — Effect of cold upon the digestion. — Too 
much clothing. — Overcoats. — Dressing of girls. — Night- 
clothing. 

Importance of Puke Air 54 

Oxygen as food. — Detection of impure air. — Source of air 
pollution. — Deleterious effect of impure air. — Air of the 
nursery. — Poisonous exhalations from lungs and skin. — 
House filth. — Micro-organisms. — Ventilation. — Catarrhal 
condition. — Breathing through the nose. — Mouth breath- 
ing. — Its dangers. — Delicacy of frame the result of modern 
ways of life. — Benefits of free ventilation. — How to pre- 
serve pure air in the house. — Damp cellars. 

Exercise a Requirement for Health 72 

Its effect. — Result of its neglect. — Combining physical and 
mental training. — Outdoor games. — Lawn tennis for girls. 
— Exercise versus drugs. — Indoor life and its result. — Out- 
door exercise in all weather. — Growing pains. — Play-room. 
— Toughening children. 

Sleep 80 

Dr. Hammond on sleep and rest. — Sleep during childhood. — 
Its duration. — Noonday nap. — Symptoms resulting from 
too little sleep. — Its importance where hereditary weak- 
nesses exist. — Its effect upon the nervous system. — Avoid- 
ance of romping and excitement at bedtime. — Night ter- 
rors. — Means favoring sleep. 

Regularity of the Bowels 86 

Removal of waste material from the system. — Constipation 
during school -days. — Causes of constipation. — Its effect 
upon health and method for overcoming the same. 

Care of the Skin 90 

Eliminative function of the skin and danger of interfering 
with it. — Baths. — Effects of cold and warm baths and their 
dangers. — Temperature. — Daily sponging. — Suggestions re- 
garding delicate children. — Friction. — Salt-water bath.— 
Its duration. — "Wading or paddling. 



CONTENTS. 



Education 100 

Increase of the diseases of the nervous system, and causes. — 
Protection of the nervous system. — Diversion of nerve-force 
from nutrition. — Early stimulation of the brain. — Age of 
commencing school. — Kindergarten. — Precocious children. 
— Hours for exercise and sleep infringed upon. — Results cf 
overstudy. — Returning to school after serious illness. 
School Hygiene 106 

Loss of health as a result of defective school sanitation. — 
School lunch. 

Discipline 108 

Obedience and self-control. — Respect for elders. — Sugges- 
tions for inculcating obedience. — A physician's experience. 
— Cause of disobedience. 

Hygienic Reflections Ill 

Laws of health as fixed as other physical laws. — Herbert 
Spencer on children. — Causes of degeneracy of health. — 
Symptoms indicative of lack of physical vigor. — Hereditary 
tendencies overcome. 

Puberty 115 

History of a case as a text on hygiene during puberty. — Com- 
parison of life to-day with the life half a century ago. — 
Sins of the parents visited upon the children. — Indications 
of approaching change. — Special care. — Protection of the 
body and feet. — Mental strain. — Sleep. — Nervousness, its 
indication. — Constipation. — Opinion of Dr. Emmet. — What 
to avoid during the catamenia. — Bathing during the month- 
ly period. — Absolute rest not intended by Nature. — Girl in 
her "teens." — Commencing school without breakfast. — 
Combining school and social duties. 

Appendix 137 

Mortuary statistics and deductions therefrom. 



HYGIENE OF CHILDHOOD. 



INTRODUCTION. 

Until within a very recent date, nearly one half 
of the total mortality in the larger cities throughout 
our country was of children under five years of age.* 
This fact affords matter for the deepest considera- 
tion, and a thoughtful mind will naturally question 
the reason of so great a destruction of life among 
the young. Investigation shows that this large mor- 
tality was mainly due to a disregard of the laws of 
health, and that obedience to these laws will very 
materially reduce the death-rate. The correctness 
of this statement may be verified by a study of the 
mortuary statistics of large cities during the past 
fifteen or twenty years, in connection with the sani- 
tary reforms in these cities ; and also by a compara- 
tive study of mortuary tables exhibiting the differ- 

* See Appendix. 



12 HYGIENE OF CHILDHOOD. 

ence in the death-rate among children in large and 
small cities, from which tables it is evident that, 
wherever the laws governing life are most carefully 
followed, there will be found a lower mortality dur- 
ing early life. "When the death-rate among chil- 
dren in larger cities can be materially reduced by 
improved general sanitation, it is obvious that the 
health and vigor of children in their homes can also 
be improved by close attention to their personal 
hygiene. 

It is interesting as well as instructive to contrast 
the death-rate among children living in modern 
cities with that among the Indians when living in 
their primitive state, before they were contaminated 
by the vices of the white man. Catlin, an earnest 
student of the customs and habits of the Indian 
tribes of North and South America, who visited one 
hundred and fifty tribes, containing over two million 
souls, tells us that he was struck with the low rate 
of mortality among their children. He states * that 
in one tribe, numbering two thousand souls, he 
learned from the chief that the death of a child 
under ten years of age was a very unusual occur- 
rence ; and in examining the cemetery of the tribe, 

* George Catlin, " Breath of Life," p. 10. 



mm od uctiok i 3 

where the dead, enveloped in skins, were left rest- 
ing separately on little scaffolds of poles, he could 
discover, among one hundred and fifty embalm- 
ments, but eleven of children. Statistics from every 
other tribe visited corroborated the same statement. 
In one of the smaller tribes, there had occurred 
during ten years only three deaths - among children 
under ten years of age. The query arises as to the 
cause of this wonderful difference in mortality be- 
tween civilized and primitive communities. The 
life of the uncivilized Indian child of the past was 
a mere animal existence: his ancestral stock was 
sturdy and healthy, he breathed a pure air, was given 
simple food, had abundance of sleep, and nothing 
to excite and exhaust the nervous system. In early 
life he was well protected from cold, and was 
taught regularity of habits and self-control. How 
this contrasts with the personnel of most children of 
to-day can be best answered by each mother. 

Naturally we would not advocate going back to 
the habits and life of the savage in order to obtain 
vigor of childhood, but certainly instructive lessons 
may be learned by studying the causes which led 
to vigorous health among Indian children. Owing 
to the requirements of civilization, which demand 
of us more than a mere animal existence, we can 



14 HYGIENE OF CHILDHOOD. 

not expect the low rate of mortality that existed 
among the Indians in their primitive state. We 
can and should have, however, with the highest 
state of civilization, a far lower death-rate among 
children than generally exists. The requirements 
of health are all extremely simple, and can be 
brought into application in every household. The 
drawback to the modern life — as far as it affects 
childhood — has been that study and cultivation 
have been extended to what have been considered 
weightier matters than the physical and nerve 
health of the young, which has been more or less 
neglected. Traditional customs have been the rule 
for guidance rather than true intelligence. 

The benefits derived from following certain 
laws and regulations necessary for the maintenance 
of health throughout the period of infancy, are ap- 
preciated by all observant mothers. They recog- 
nize the importance of the formation of regular 
habits at an early age, and also the necessity of a 
full amount of sleep at regular hours ; of a care- 
fully selected variety of food given at stated inter- 
vals ; of the protection of the body from chill by 
proper clothing ; of pure air to breathe indoors ; of 
cleanliness and plenty of sunlight and outdoor air. 

After babyhood, vigilance in following the regu- 



INTRODUCTION. 15 

lations observed during infancy is so often relaxed 
that I desire to impress upon my readers the fact 
that it is of equal importance to enforce these same 
rules during the whole period of childhood, in order 
that the development of the child may not be re- 
tarded or interfered with. 

Infancy includes the space of time from birth 
to the completion of the first dentition — about two 
and a half years — when childhood may be properly 
said to begin. The little one can now make known 
its wants and discomforts ; the dangers incident to 
dentition are over; the nervous system is less sus- 
ceptible to all impressions, and not so easily dis- 
turbed by injudicious feeding or exposure to cold, 
dangers which are so disastrous at an earlier 
age. 

In proportion, to the proper guidance and atten- 
tion given the child during the earlier years of 
life will be the strength of its body at maturity. 
This subject, the care of children, is one that should 
be studiously considered by all parents, and should 
receive more earnest thought than any duty ; for, 
through want of knowledge on this subject, thou- 
sands of parents are guiding to a physical perdition, 
and leading to an early grave, their children, for 
whose future happiness they would willingly sacri- 



16 HYGIENE OF CHILDHOOD. 

fice their own lives. The physical wreck in middle 
life, by which the usefulness of the individual in 
the community is thwarted, and which blights his 
hopes and ambitions, after years of preparation, too 
often originates during the years of development. 
Through faulty management during the period of 
youth, the muscles, bones, sinews, nerves, and vari- 
ous organs of the body, have not a hardy maturity. 
As a result, the apparent strength in early man- 
hood is not enduring, the feebleness of tissue and 
defective nerve -force can not withstand the de- 
mands made upon them in the battle of life, and 
the individual, like a badly framed and timbered 
ship in a storm, is unable to withstand the strain, 
and is wrecked. 

Moral, mental, and physical training of children 
are equally important, but I shall chiefly confine 
my remarks to the physical, which, if properly 
conducted, insures a more complete enjoyment of a 
good moral and mental training. I wish, however, 
to suggest one thought for consideration, namely, 
that the moral welfare of a being is very often de- 
pendent upon, or influenced by, the physical and 
mental condition. With a healthy body and 
healthy nerve-force there is far less likelihood of a 
low state of morals than when the physical system 



INTRODUCTION. 17 

is imperfect, when the digestive organs have been 
perverted by improper and too stimulating food, 
and the nerve -force exhausted by too profound 
mental work, and an insufficient amount of sleep 
during the period of youth. 

In the works of Nature, unvarying regularity 
must be observed in order that perfection may be at- 
tained, and the workings of the human organism are 
no exception to this established rule. The organs 
of digestion acquire the habit and power of digest- 
ing food at regular intervals, the bowels of dis- 
charging the waste material, and the brain of seek- 
ing repose ; and various disturbances in their func- 
tions and in the system result if there is any inter- 
ruption in their habits. 

During these important years, therefore, when 
the child is rapidly developing, no pains should be 
spared to establish habits of regularity. They are 
essential to a healthy existence. "When once fairly 
established, Nature's love for order will create a de- 
sire in the child to continue these habits. That 
which at first may have been difficult to implant, 
takes deep and permanent root. 



18 HYGIENE OF CHILDHOOD. 

DIETAKY DUKING CHILDHOOD. 

All the tissues and organs of the body require 
for their healthy development blood of a good, nour- 
ishing quality and of sufficient amount, to obtain 
which it is essential that the material from which 
the blood is made, food, should be suitable both in 
quality and quantity, and that the digestive organs 
which transform the food into blood should per- 
form their functions in a perfectly healthy manner. 

It is a truism that, during childhood, simplicity 
of food is essential to perfect digestion. In order 
that the functions of digestion may be properly 
carried on, such food only should be given as can 
be digested with ease, and then these functions 
should be allowed an interval of rest before the 
next meal. By rest, is meant a period of time 
when the glands — whose duty it is to manufacture 
the digestive fluids — are not in active operation. 

This glandular activity ceases only when there 
is no food in the stomach and intestines, or when 
the food is in a condition for absorption. If the 
necessary amount of rest is not obtained, then these 
glands are kept too long in a state of congestion,* 

* By congestion is meant that a greater amount of blood is sup- 
plied to the part in question than is the case when the part is in a 



DIETARY DURING CHILDHOOD. 19 

and soon cease to do their work properly, and there 
results what is commonly called an attack of indi- 
gestion, the stomach and bowels becoming irritable, 
and loss of appetite and strength, fever, pain, vom- 
iting, diarrhoea, etc., ensuing. It is just as absurd 
to expect that the stomach of a young child should 
be capable of digesting the hearty food suitable for 
an adult as to expect that its arms should lift as 
heavy a weight, or its legs should carry it as fast 
or as far. 

Food is taken into the body for the purposes of 
growth, for the formation of animal heat, and for 
the restoration of tissues that are destroyed or used 
up in the maintenance of the various functions of 
the animal organism. It may be subdivided into 
three great classes — the carbonaceous, the nitroge- 
nous, and the mineral salts and water. 

The oily, fatty, and saccharine elements in food 

state of repose or inactivity. When any one function of the body is 
called into activity, as the brain in thinking, the stomach or intesti- 
nal canal in digesting, the liver or any of the various glands or or- 
gans of the body in the performance of their duty, there instantly 
takes place an accession of blood at the point of increased activity, 
and a healthy state of congestion takes place. If, however, this 
congestion is too long maintained from the excessive amount of 
work required, the healthy action of the gland or organ is interfered 
with, and a diseased state is the result. Congestion is also brought 
about through the agency of cold, as we shall see later on. 



20 HYGIENE OF CHILDHOOD. 

— classed as carbonaceous— are chiefly appropriated 
for the formation of heat and the nutrition of the 
nervous system, and that which is not immediately 
utilized is deposited as fatty or adij)Ose tissue be- 
neath the skin. This adipose tissue fulfils a three- 
fold mission — it rounds out and beautifies the body ; 
it protects the inner organs and deeper structures 
from injury ; and is a reservoir for providing the 
heat-making powers with fuel and the nervous sys- 
tem with food whenever an extra amount is called 
for. The nitrogenous element in food is principally 
used in the formation of the muscular structure and 
the fibrous framework, and derives its chief supply 
from animal meat ; eggs, and some of the cereals 
and vegetables, however, furnish a large amount of 
this element. 

Purely carbonaceous food can not supply mate- 
rial for building up strong muscular or fibrous 
structure, nor can purely nitrogenous food keep up 
the necessary degree of animal heat and vigorous 
nerve-force. A mixed diet, therefore, is essential 
to the proper development of the body. It is, 
moreover, important to give du,e thought to the 
character of food, in order that every tissue may 
have abundance of its own necessary nutriment. 
That is, the bony structure should be able to select, 



DIETARY DURING CHILDHOOD. 21 

from the food taken in, sufficient phosphate of lime 
and other mineral salts for the building up of a 
firm, solid framework. The muscles should hare 
an ample amount of nitrogenous food in order that 
they may grow stronger. So, too, the nervous sys- 
tem demands a large supply of food containing fat 
and the phosphates in order that it may possess a 
healthy nerve-force and the ability to maintain the 
necessary degree of animal heat. 

During the early months of life, milk furnishes 
all that is requisite for the development of every 
part of the little being. But with growth there is 
an increased demand upon the muscles and other 
tissues for work, so that additional and heartier 
food is required to maintain a sufficient supply of 
nutriment. Milk, however, containing as it does 
elements that nourish brain, muscle, and nerve, and 
give fuel for animal heat, should constitute one of 
the staple articles of diet for all children through- 
out the whole period of adolescence, and its use 
should always be encouraged. It is unequalled as 
an article of food for the young, since all its com- 
ponent parts are quickly assimilated and appropri- 
ated in the system without any undue tax upon the 
digestive organs. The fat of milk being in a state 
of fine subdivision and readily taken up by the ab- 



22 HYGIENE OF CHILDHOOD. 

sorbents of the digestive tract, is especially benefi- 
cial and more acceptable than the fatty elements 
contained in other varieties of food. 

Children after leaving babyhood not unfrequent- 
ly rebel against milk, manifesting a disgust for it. 
Parents should be careful not to yield to these 
whims, as in the vast majority of cases it is nothing 
but fancy, for this food is too valuable an article of 
diet to be hastily put aside. If the milk is very rich 
with cream, it may occasionally give rise to disor- 
dered digestion, especially with children of a so- 
called bilious temperament. The milk from the 
Alderney cow may not agree with some children on 
account of its richness in cream, while that from 
the common cow will be perfectly acceptable. In 
fact, with the majority of children, young and old, 
the milk from the common cow is preferable to 
that from the Alderney. "When there is an actual 
distaste for milk, the addition of a little salt will 
give it more relish, just as salt improves the flavor 
of meat. 

Certain of the cereals rank next to milk as 
articles of nutriment. Oatmeal, wheaten grits, 
hominy, imperial granum, rice, and farina are the 
most valuable, and should form part of the child's 
diet. Of these oatmeal is the richest in nutriment. 



DIETARY DURING CHILDHOOD. 23 

Analysis shows that it contains a higher percentage 
of fat and mineral salts (phosphate of lime chiefly) 
than any of the other cereals, and with the excep- 
tion of corn it contains more sugar. It is also rich 
in nitrogenous or albuminous principles, but has a 
smaller percentage of starch than the other grains. 
There is one other element in oatmeal which may 
become as much a source of danger as it is of bene- 
fit. I allude to the cellulose or cell structure. It 
contains more of this waste material than any other 
cereal. The danger lies in the fact that the digest- 
ive fluids can not obtain ready access to the nutri- 
ment incased in this cellular structure when insuffi- 
ciently cooked, as is too often the case, and the 
grain is thus rendered an indigestible article of food 
for a delicate stomach. Oatmeal should be given at 
least two and a half or three hours cooking, in order 
to disintegrate or break up the hard, cellular en- 
velope surrounding the true nutriment. When thor- 
oughly cooked it will lose its granular form and as- 
sume a gelatinous appearance. The cellular or waste 
material is beneficial because its presence in the 
bowels stimulates the peristaltic action and promotes 
daily evacuation. In proportion to size the child 
requires a greater amount of food for nerve nutri- 
tion and for developing heat than the fully devel- 



24 HYGIENE OF CHILDHOOD. 

oped man ; this is necessary in order to supply the 
wants required in growth and the force expended 
in restless activity. 

In addition to fat, there is another article which 
is heat-making, namely, sugar, and also to a slight 
degree the starch of farinaceous food, for the starch 
is converted into sugar in the system. The natural 
longing for sweets is often more than a desire to 
gratify the palate. It is a craving upon the part of 
nature for carbohydrates. It is, therefore, perfectly 
natural, under certain restrictions, to give sugar or 
molasses with food. The great danger, in giving 
saccharine articles of food, consists not so much in 
their use as in their abuse. A certain amount of 
sugar or candy is harmless for children, but it should 
be given with food, or immediately after eating, and 
in small quantities. "When sweets or candies are 
given between meals, an acid fermentation is apt 
to take place, the digestion becomes deranged, the 
appetite fails, and does not return until the sweets 
are abandoned. Children whose diet is largely com- 
posed of farinaceous food and milk, with a proper 
amount of butter, do not as a rule crave sweets as 
strongly as when these articles are sparingly given. 
The rule I would suggest is that, when a child is 
vigorous, with digestion in good order, and takes 



DIETARY DURING CHILDHOOD. 25 

plenty of milk and farinaceous food, yon may give 
sweets and candies in moderation ; but when the 
digestion is defective, appetite poor, tongue coated 
or the child is delicate, sweets should be withheld. 

Eggs constitute a concentrated and digestible 
nutriment. The white is composed chiefly of albu- 
men, a nitrogenous element, and the yolk largely 
of fat. 

Meat is essentially a nitrogenous article of diet ; 
it builds up the muscles, but, as muscle-making or 
nitrogenous elements are also found in farinaceous 
food, white of eggs, and milk, a large amount 
of meat is not necessary. On the contrary, it is 
actually injurious, as, if it forms the greater part of 
the meal, it thereby deprives the system of the fat 
and nerve making food, which is so essential for 
animal heat and nerve-force, and it, moreover, acts 
as an irritant upon the bowels and kidneys. Young 
children who are large meat-eaters are very slender, 
prone to have coated tongues, foul breath, and indi- 
gestion. They are also given to talking in their 
sleep; whereas, when the diet consists largely of 
milk, farinaceous food, light vegetables, and only a 
judicious amount of meat, children are fatter, have 
a healthier complexion, rosier cheeks, and are gener- 
ally of a happier, brighter disposition. It is well to 



26 HYGIENE OF CHILDHOOD. 

teach children, when they are old enough to take 
hearty food, that they should eat the fat of meat. 
Pat is important for developing nerve-force. It is 
also essential, as we have already stated, for keep- 
ing np animal heat, and furnishes the basis of all 
cell nutrition. By fat we do not mean grease. 
The natural fat that is taken with meat, milk, and 
butter is wholesome and desirable, and is very easily 
assimilated ; but made meat-gravies and all kinds of 
food fried in grease are indigestible, and should 
never be given to a child. 

An instinct evinced by most children is the 
desire for vegetable acids — in the form of fruit. 
This desire should be indulged. Where note is 
taken of what nature thus craves, by supplying a 
sufficient quantity of good ripe fruit, the child will 
not resort to the sour, unripe apples, gooseberries, 
and other fruit which are such prolific causes of 
bowel trouble in summer. Ripe fruit is not only 
acceptable to children, but it is an important article 
of diet for them. When fruit is taken in modera- 
tion, the vegetable acid contained therein exerts a 
beneficial effect upon the digestive organs, being in 
itself a good tonic. 

During the early years of childhood — that is, 
from two to six years of age — milk should consti- 



DIETARY DURING CHILDHOOD. 27 

tute the greater portion of the food ; of course, fari- 
naceous food, easily digestible vegetables, good ripe 
fruit, eggs, and meat should be given. The impor- 
tance of the last article, meat, is however apt to 
be overestimated during early life. A little fresh 
meat once a day should be given, but, except from 
ill health, and by the advice of a physician, a child 
under seven should never have meat more than 
once a day. 

As the child approaches the age of eight or 
nine years — when it is full of life and vigor — 
meat is generally required more than once a day 
— that is, meat with the dinner, and a little in 
the morning for breakfast. Be careful, however, 
not to let meat diet crowd out other varieties of 
food. A vigorous child of twelve or fourteen years 
of age requires as much nutriment as a grown man. 
The taste for fresh vegetables should be cultivated ; 
roasted and mashed potatoes, fresh peas, string 
beans, asparagus, boiled onions, lettuce, and spinach, 
are especially digestible and desirable for children 
over three years of age. The vegetable acids assist 
digestion, and the cellular matter contained in the 
vegetable, by stimulating the bowels to healthy ac- 
tion, is instrumental in eliminating from the system 
waste material. Celery and tomatoes raw, also 



28 HYGIENE OF CHILDHOOD. 

the following cooked vegetables — beets, cauliflower, 
turnips, corn, parsnips, carrots, cabbage, egg-plant — 
should be given only to older children. Ham, 
pork, liver, tongue, corned beef, and all salted 
fish are difficult of digestion and should be forbid- 
den food for young and delicate children. Fresh 
meat should be either roasted, boiled, broiled, or 
stewed, but should never be fried. Fresh fish and 
oysters are wholesome, and help to vary the bill of 
fare for older children. Pastry, fresh home-made 
bread, and hot biscuits are articles of food very dif- 
ficult of digestion, and should never be given to 
young children. If a child of twelve or fourteen 
years of age is robust, has good digestion, and eats 
heartily of proper food, pastry can now and then 
be given, but should be absolutely avoided under 
any other circumstances. To a child under thir- 
teen years of age tea and coffee should never be 
permitted ; indeed, it would be better to postpone 
their use as long as possible. They are unneces- 
sary; besides, they are excitants, and are prone 
to derange the digestion. To maintain a healthy 
digestion all stimulating food should be rigidly 
avoided. Pickles, pepper, spices, and highly sea- 
soned food should be forbidden, not only for the 
same reason that we forbid tea and coffee, but 



DIETARY DURING CEIIDHOOD. 29 

because they pervert the appetite, create in the 
child a desire for highly seasoned food, which de- 
sire, when fostered, leads in turn directly to intem- 
perance in later life. If, during childhood and early 
youth, the stomach were kept free from the bane- 
ful influence of all stimulating food, I am convinced 
that there would be fewer drunkards. 

A child of from three to five years of age is too 
frequently put to bed immediately after eating a 
supper consisting of milk, bread and butter, and a 
liberal allowance of jam. The mother or nurse 
comments the following morning on the restless or 
dreaming and startled sleep of the child, and rarely 
connects the supper allowance of jam with the re- 
sultant night-dreams. The supper of a child of this 
age should be very simple — bread and milk, or 
cereals and milk, with bread and butter is all that is 
necessarj^. The jam causes indigestion, distends the 
bowels with wind, and disturbs the whole circula- 
tion, especially of the brain. 

Little or no harm will be experienced by per- 
mitting a child to completely satisfy the appetite, 
provided the food is thoroughly masticated and 
eaten slowly. It is only when indigestible food is 
taken, or when the food is " bolted," that there is dan- 
ger of overfeeding and of harm ensuing. 



30 HYGIENE OF CHILDHOOD. 

Children during school-life must be abundantly 
fed, for not only is the growth rapid but there is 
a great wear and tear of body and mind while at 
work and at play. If they are not properly nour- 
ished at this critical time, they develop badly, their 
blood becomes poor, and hereditary tendencies are 
encouraged. Variety and palatability of food must 
be studied as well as regularity of meals. At this 
period — that is, after six or seven years of age — it is 
always important to see that the interval between 
meals is not too long, for by prolonged fasting many 
children are very much injured. A glass of milk, or 
a little bread and butter between breakfast and din- 
ner, or between dinner and supper, is a great help 
in sustaining strength and vigor, and very impor- 
tant to a child who is delicate, or whose appetite 
is small. It is permissible, also, to give between 
meals, to a child who is taking a great deal of ex- 
ercise, light, digestible food of the kind mentioned, 
provided it is given with a degree of regularity, 
and not near the hours for the regular meals. If, 
on the other hand, the child is allowed to eat at 
irregular intervals, whatever and whenever the ap- 
petite dictates, the functions of digestion are often 
so perverted that, for the remaining years of life, 
he is likely to become a confirmed dyspeptic; and 



DIETARY DURING CHILDHOOD. 31 

dyspepsia, as we know, is but the starting-point of 
many diseases. Sir Henry Thompson, in his little 
monogram on " Diet in Kelation to Age and Activ- 
ity," says . . . " I have for some years past been 
compelled, by facts which are constantly coming be- 
fore me, to accept the conclusion that more mischief 
in the form of actual disease, of impaired vigor, 
and of shortened life, accrues to civilized man, so 
far as I have observed in our own country and 
throughout Western and Central Europe, from 
erroneous habits in eating, than from the habitual 
use of alcoholic drinks, considerable as I know the 
evil of that to be." * 

If erroneous habits of eating have such a bane- 
ful effect upon adults, the effect upon those of ten- 
derer years must be manifestly greater ; and it cer- 
tainly behooves parents carefully to scrutinize the 
quality of food provided for their children, as well 
as the manner and time of taking it. 

Whenever the digestion is deranged, there is 
not only a deprivation of a certain amount of nutri- 
ment, but the incomplete products of digestion, 
which are taken into the circulation, exert a delete- 
rious effect upon the nervous system, and create 

* Sir H. Thompson, " Diet in Relation to Age and Activity," p. 4. 



32 HYGIENE OF CHILDHOOD. 

more or less irritability of temper, or a condition of 
moroseness. When this state is of short duration, 
no serious results follow; but when frequently re- 
peated, or if long continued, a lasting impression 
upon the temperament and physique is the result. 
Theu, again, if the digestive tract is frequently dis- 
turbed, and especially if the liver is kept in defect- 
ive action, owing to irregular or improper kinds of 
nutriment taken during the period of youth, that 
time when the healthy growth and development of 
these parts should take place, an imperfect or mor- 
bid development is apt to ensue, which must result 
in impaired health and disease in later life. 

During the period of school-life, meals are apt 
to be taken with great irregularity. Hurrying to 
school, and again hastening to afternoon play, cause 
the child to forget hunger in the eager desire to 
join his comrades ; then coming home with hearty 
appetite sharpened by exercise, he will eat often 
whatever he can find, however indigestible, and the 
true appetite for the following healthy meal is 
gone. The child should not only have his meals 
regularly, but he should be compelled to spend 
sufficient time at them — to eat slowly and without 
excitement. Food should be carefully cut in small 
pieces before putting it into the mouth, and masti- 



DIETARY DURING CHILDHOOD. 33 

cated thoroughly, in order that, when it reaches the 
stomach, the digestive juices can act upon it and 
more readily reduce it to a solution for absorption. 
Hurry and excitement when eating divert the at- 
tention of the nerve-force from the act of diges- 
tion, and consequently food is not so well digested. 
Eepose and quietness, on the other hand, favor the 
digestive act. It is therefore important that a 
child should be compelled to eat slowly, and never 
be permitted to leave the table until all shall have 
finished ; otherwise the food is likely to be insuffi- 
ciently masticated, and the habit of " bolting " his 
food will soon be acquired. 

It will be often observed that children of deli- 
cate physique, possessing an active and nervous 
temperament, play with so much earnestness that, 
although eating generously for breakfast, they have 
a poor appetite for dinner and supper, and in con- 
sequence do not obtain the necessary amount of 
nutriment. This too active exercise just before 
meal-time creates a physical exhaustion which the 
child in his excitement does not recognize, but 
which has affected his digestive organs. This fail- 
ure of appetite may be averted by enforcing com- 
plete rest for half an hour or more preceding each 
meal. 



34 HYGIENE OF CHILDHOOD. 

A child's digestion may be seriously impaired 
by unsuitable lunch prepared for him to take to 
school. Such injurious things as pies, cakes, and 
sweets, are slipped into the basket, to " tempt his 
appetite," or he is given a few pennies with which 
to purchase tarts and cakes from the nearest con- 
fectioner. I need not say that this habit is pro- 
ductive of immense mischief; indigestion, a sour 
stomach, and loss of appetite for the regular meal 
awaiting his return from school, are but a small part 
of the damage. The lunch should be simple, appe- 
tizing, and put up in an attractive form, in clean 
fresh doylies rather than paper as a wrapper inside 
the basket, and it should consist of nicely prepared 
bread and butter, or sandwiches made with mutton, 
beef, or chicken, finely chopped or in slices, one 
or two hard-boiled eggs for older children, or the 
yolk of a hard-boiled egg. A little stale sponge- 
cake, or a few ginger-snaps, or well- cooked ginger- 
bread and fruit, may be allowed, provided there is 
a certainty that the more substantial nourishment 
is also eaten. Sandwiches made with ham or cold 
corned beef should not be given. A child under 
ten years of age should never be kept at school 
long enough to necessitate carrying a luncheon. If 
the school opens at nine o'clock, the child should 



DIETARY DURING CHILDHOOD. 35 

return by half-past twelve, and the school hours for 
the day be finished. In the case of older children, 
the custom existing in many country towns of a 
long intermission from twelve until two o'clock is 
certainly beneficial to health. It allows sufficient 
time to walk home leisurely, and to eat quietly, 
so that the digestive process is fairly under way 
before returning to the afternoon duties. 

Errors in diet bring about disastrous effects aside 
from depriving the child of robust health through 
lack of the proper kind of nutriment. There is a 
close relationship between the digestive organs, the 
mouth, the upper part of the throat, and, to a cer- 
tain extent, the nose. This connection is in a meas- 
ure evident to every one who has given any thought 
to the symptoms of disease, as shown in the coated 
tongue ; and most observant mothers recognize that 
croup and canker-sore mouths are manifestations of 
stomach trouble, few realizing, however, that swollen 
tonsils, sore throat, thickened and roughened catar- 
rhal state of the back part of the throat and nose, 
may originate from the same cause which gave rise 
to the coated tongue. False croup, which strikes 
terror to the heart of the mother by its sudden 
advent at night, is almost invariably due to some 
error in diet on the day previous, or is the result 



36 HYGIENE OF CHILDHOOD. 

of cold disturbing the digestion and arresting the 
action of the liver. Canker in the mouth, or an 
ulceration of the mucous membrane of the mouth, 
is the direct result of an acrid condition of the 
stomach. So, too, a general catarrhal state of the 
upper air-passages (nose, pharynx, and larynx) is 
frequently resultant from oft-repeated errors in 
diet, as when pastry, too much sweets, condiments, 
and other improper articles of food are given ; and 
when this catarrhal condition is brought about from 
other causes, it is fostered and aggravated by mal- 
digestion. 

Unwholesome food, therefore, exerts a twofold 
injury on a child : through its irritating effect, there 
is a loss of appetite, lack of perfect assimilation of 
food, and consequently a deprivation of proper ele- 
ments for building up healthy tissue ; and also the 
induced indigestion frequently creates a catarrhal 
state of the upper part of the throat and nose, a 
condition, which, as I shall explain later on, is of 
great detriment to perfect health. 

The question should children be permitted to 
follow out their own fancies regarding the food they 
are to eat, is a subject often discussed by parents. 
Because there is a dislike to oatmeal, or hominy, or 
meat, or milk, or any other article of food suitable 



DIETARY DURING CHILDHOOD. 37 

for a child, shall this dislike indicate the bill of fare, 
and the distasteful article be omitted ? I must from 
my own observation give a negative answer. A 
young child is a perfectly helpless being, dependent 
for all things upon the guidance of its elders; with- 
out instruction it is incapable of selecting proper 
food. I might almost say that the appetite is by 
nature perverse, and requires as much guidance as 
the morals and education. The youngest child will 
often take with apparent relish tea, coffee, wines, 
brandy, spices, and food which a judicious person 
knows must be harmful to its delicate stomach. In 
the majority of cases a child's taste may be culti- 
vated for any article of food. Unsavory food, in- 
sufficient cooking of farinaceous food, and sameness 
of bill of fare, aside from notions and whims, are 
great causes for creating dislike to certain articles 
of diet. The same food should not be given with 
such frequency that children begin to dislike it. It 
must be remembered that a variety is essential to 
good appetite and digestion. 

One mother will say that her children will not 
eat farinaceous food, another that they will not 
drink milk, another that they will not take vegeta- 
bles. "When this is the case, the inference is that 
the mother has not exerted proper control, or com- 



38 HYGIENE OF CHILDHOOD. 

menced the guidance of her children early enough. 
With a few exceptions every child can be taught to 
take farinaceous food, milk, vegetables, and all 
articles suitable for a child to eat. In cultivating a 
liking for a distasteful food, place only one or two 
tea-spoonfuls of the food on the child's plate, and 
insist upon it being eaten or taken as a dose of 
medicine ; if this is repeated from time to time, but 
not too frequently, the taste for the food will in the 
majority of instances be acquired. If, however, a 
large quantity of the distasteful article is placed 
before the child, the horror and disgust for it will 
be intensified. I have known a great many in- 
stances where, by following this suggestion, children 
have acquired a fondness for the food which they 
formerly abhorred. 

Enforcing a bill of fare that is distasteful re- 
quires, however, good judgment, because children as 
well as adults have idiosyncrasies, and may be un- 
able to digest certain food eyen though it be good. 
If, therefore, after a fair trial, it is fully ascertained 
that a child thoroughly abhors certain articles of 
diet, and can not digest them, it is only right that 
the objectionable articles should be discarded. It 
often happens that children who are whimsical and 
notional about food, who rule their parents, and are 



PROTECTION OF TEE BODY. 39 

their own guides as to what they will or will not 
eat, are apparently none the worse for the improper 
food; it is when illness overtakes them that the 
results of this misguidance are apparent. I recall 
many instances where children, who, when in health, 
had been allowed to gratify their appetites, and had 
never been taught to exercise self-control and. to 
observe obedience in eating, have refused, when 
they became seriously ill, every article of diet usu- 
ally administered to the siclc. Nourishment was 
given only under an excitement and struggle, 
although pie, cake, hot bread, and other accus- 
tomed articles of food were called for. How 
different the case when a child obeys and takes 
all food given ! I have known, repeatedly, cases 
where the lives of children, precious to their par- 
ents, could have been saved if the parents had 
exercised a little more judgment, and had not only 
taught their children to eat proper kinds of food, 
but had enforced obedience in eating whatever was 
placed before them. 

PKOTECTION OF THE BODY. 
The physiological action of cold and its danger- 
ous effect upon the human frame seem to be imper- 
fectly understood by most parents. They associate 



40 HYGIENE OF CHILDHOOD. 

the immediate result of a cold, in creating a cough, 
or some disorder of the breathing apparatus, as 
about the only evil resulting from undue exposure, 
or from chilling the surface of the body through too 
scanty clothing, and appear to be unaware of the 
disastrous disturbance a cold produces in other or- 
gans of the body. It is a peculiarity of the human 
frame that a definite standard of heat must be main- 
tained in order to have perfect health. This stand- 
ard is always the same, whether one is living in the 
arctic region or at the equator, the body having 
means within itself of preserving this fixed degree 
of temperature. The forces that originate animal 
heat make a positive requisition upon the nutri- 
ment taken into the system for enough material 
from which is developed the heat necessary to main- 
tain the required degree of temperature. This 
amount they must have, and that which remains, be 
it much or little, is appropriated for growth and the 
renovation of the tissues that are wasted. When 
the body is not sufficiently clad, there is a loss by 
radiation of a certain amount of heat, a lowering of 
the surface temperature. This necessitates an extra 
effort of the system to supplement the heat that has 
been lost in order to preserve the proper standard, 
and an expenditure of material which could other- 



PROTECTION OF TEE BODY. 41 

wise Lave gone to build up the frame and strength- 
en the tissues of the body. Should this expenditure 
continue for any length of time, the result would 
be a body small in size, or inferior in texture, or 
both. 

Inasmuch as but a definite amount of food can 
be taken into the body, and from this all the animal 
heat must be developed, as well as all the material 
for growth obtained, it is of the greatest importance 
that the body should be thoroughly protected dur- 
ing the maturing years, so that the growing tissues 
may not be deprived of their full share of nutriment 
through any unnecessary call for material in the for- 
mation of heat. Liebig says, " Our clothing is, in 
reference to the temperature of the body, merely an 
equivalent for a certain amount of food." When 
the body is insufficiently clothed, the nerve-force is 
in a measure exhausted in its efforts to maintain the 
normal temperature, and in consequence there is a 
depression or loss of vitality, with a resulting disturb- 
ance of all the functions, in addition to a defective 
nutrition of the tissues. In other words, cold is a 
powerful nerve depressor. 

The blood is, moreover, driven by the cold from 
the surface of the body to the inner organs, produc- 
ing in them a low form of congestion and an added 



42 HYGIENE OF CHILDHOOD. 

impairment of their functions. The excretory glands 
of the skin are also hindered in their duty through 
insufficient protection. It is to be borne in mind 
that the skin excretes, or allows to pass through it, 
a large amount of waste or used-up material. In 
the adult from one to two and a half pints of fluid, 
containing effete or deleterious matter, pass through 
the glands of the skin every twenty-four hours. It is 
computed that there are no less than seven million 
respiratory glands on the surface of the body of an 
adult of ordinary size, and that these glands, if placed 
end to end, would cover a distance of nearly twenty- 
eight miles.* In the child there is naturally a smaller 
number of glands. Proportionately to its size, how- 
ever, the skin of a child excretes more fluid than 
that of the adult. Now, if the skin is not properly 
protected, the blood which carries the waste mate- 
rial to the glands is driven from the surface, and the 
waste material must find its way out of the system 
through some other organ, and in so doing over- 
taxes this organ and renders it liable to disease. 
This used-up or effete matter is also retained in the 
circulating fluid, the blood, longer than it should be, 
and consequently helps to vitiate the system and to 

* Carpenter's " Physiology." 



PROTECTION OF THE BODY. 43 

render it more liable to bowel and lung trouble, dis- 
ordered digestion, and disease in general. 

When the infant emerges from babyhood, at two 
and a half years, as it begins to run about and show 
off its pretty, attractive little ways, mothers are very 
apt to forget the importance of warmth and thorough 
protection of the body, and are led to indulge their 
fondness for pretty effects by dressing the little one 
too often in short socks, thereby leaving the legs ex- 
posed. From the second to the fifth year many 
children are very imperfectly protected. Let me 
urge all who have anything to do with children 
during this period, to see that the whole body 
is thoroughly protected. Long stockings should be 
worn throughout the whole year, and merino drawers 
and high-neck, long-sleeved under-shirts during the 
colder months of autumn, winter, and spring. The 
same care throughout the whole period of childhood 
is necessary for the foundation of vigorous health. 
Wool is a poor conductor of heat, and keeps the 
body warm by preserving about it the heat 
formed within. Linen and cotton, on the other 
hand, are good conductors of heat, and allow its 
rapid escape. When garments of wool are worn 
next to the skin, there is less susceptibility to the 
shock of any sudden atmospheric change, than 



44 HYGIENE OF CHILDHOOD. 

when linen or cotton is worn. There is also a 
greater equilibrium of the circulation and a more 
harmonious working of the inner organs. Woolen 
under-garments, moreover, stimulate the surface by 
friction, and assist by this means in maintaining a 
healthier condition o± the skin, and prevent the 
too rapid cooling of the body when heated from 
physical exercise. 

The receipt of the celebrated physician, Dr. John 
Hunter, for rearing healthy children, was " plenty of 
sleep, plenty of milk, and plenty of flannel." 

The variability of the climate of the North At- 
lantic States calls for close attention to the protec- 
tion of the body. The sudden alternation of heat 
and cold, which is characteristic of most of our cli- 
mate, is a prolific cause of illness, which is not 
brought about through breathing the colder air — as 
many suppose — but is induced by the change of 
temperature from warmer to colder air, creating a 
sudden revulsion of the cutaneous circulation, and a 
consequent congestion of the internal organs. Any- 
thing, therefore, which will prevent this revulsion of 
the surface circulation will be instrumental in pre- 
serving health. In merino and other woolen un- 
derwear we have the best means for accomplishing 
this object. 



PROTECTION OF THE BODY. 45 

If tliis thorough protection is enforced, there 
will be fewer cases of consumption and nerve de- 
pression in after-life. Through cold a shock is 
often given which, although not appreciated at the 
time, produces an effect later. Like the tender 
plant put out too early in the spring, and affected 
by the spring frost, it may still grow, but it is 
stunted and unproductive, or, if productive, its fruit 
is not so abundant or large as that from the plant 
which has received more protection in early life. 
The laws of growth and life are the same in the 
animal as in the vegetable kingdom. 

The necessity of suitable clothing for the young 
has been very pointedly exemplified in the case of a 
little child, two and a half years of age, who has re- 
cently been under my care. During the summer, 
the child was the picture of health and beauty. 
Late in the autumn I was consulted by the mother, 
who was very anxious about her little daughter. I 
found the child thin and pale, her ears of a waxy 
color. She was peevish, wakeful at night, with 
small appetite, disordered digestion, bowels at times 
constipated and frequently much relaxed. She was 
dressed — but how? Her arms were covered with 
very thin stuff, feet clothed with short socks and 
slippers, while the legs were bare for two thirds of 



46 HYGIENE OF CHILDHOOD. 

their length. The only remedy prescribed was 
warm stockings long enough to cover the whole leg, 
merino drawers, and long-sleeved undershirt. The 
result was that, after the lapse of a month, the 
child's health and beauty were restored. This is 
not an uncommon experience. Many children are 
kept in a fretful condition, are pallid, with defective 
appetite and digestion, and thousands more are sent 
to their graves, all owing to the exposure of arms 
and legs indoors as well as out-of-doors during the 
spring, autumn, and winter. I could narrate case 
after case where health, happiness, and brightness 
have been restored by simply clothing the child in 
woolen under-garments, and protecting the feet with 
warm shoes. The danger to the system, resultant 
from imperfectly protected feet and legs, is greater 
than most mothers realize. The sole of the foot is 
freely supplied with an interlacing of blood-vessels, 
by means of which the whole systemic circulation 
can be chilled and affected if the foot is not amply 
protected. "When the bottom of the foot has 
merely a thin piece of leather between it and the 
cold, damp ground, there must take place a revul- 
sion of the circulation, the blood is driven back to 
the central organs, creating in them some disorder, 
and an increased duty is demanded of the nervous 



PROTECTION OF TEE BODY. 47 

system to keep up the proper equilibrium of the 
blood-current. The shoe, therefore, should be thick 
enough to protect the foot from cold and exclude 
the dampness. Every boy, and perhaps girl also, 
must, as the natural result of active play have, at 
times, wet feet — one of the unavoidable risks of 
childhood. It is important, however, to impress 
upon the child the necessity of quickly changing 
shoes and stockings when they become wet or 
damp. 

The appearance of a child is too often the domi- 
nant thought, rather than that the manner of dress- 
ing it should be conducive to health. With its 
pretty white frock, short socks, and sli]3pers, display- 
ing its bare legs, the child is a pleasing picture for 
some mothers to look upon. When the doctor pro- 
tests against all this, he is too often met with a 
frown, and the change is objected too. " The child 
looks so pretty with short socks and bare legs," is 
one of the stereotyped replies. The custom of bar- 
ing the legs is one that has been handed down, and 
accepted by each generation of mothers as the 
proper manner of dressing, without considering the 
evil that may arise therefrom. When reminded of 
the danger, they advance the argument that " the 
child's leirs become accustomed to the cold, and 



48 HYGIENE OF CHILDHOOD. 

do not feel it," or that " they wish to accustom 
the cbild to cold, and make him tough and 
hardy." 

It must be remembered that there is a marked 
difference between the temperature near the floor, 
where the child may be playing, and of that sev- 
eral feet higher, where the parent is sitting or stand- 
ing in comfort. Would the mother be willing to 
lie flat on the floor for any length of time ? Would 
not the fear of taking cold prevent her from expos- 
ing her head to the draught on the floor ? Yet the 
child's tender legs, if they are unprotected by long 
stockings, are exposed to the same draughts which 
she fears would give her a cold in the head. Many 
of the colds and little ailments of young children, the 
causes of which are such a mystery to the mother, 
who has been " so careful," are the result of taking 
cold while playing on the floor near the base-board 
of the room, or near the window, even though it be 
shut, or near the door, under which there is gener- 
ally a space through which the air blows. A cur- 
rent of air blowing through a crack, or along one 
plane, as the current of air along the floor, is more 
dangerous to health than if one is in a colder air 
which is blowing equally about the body. It is 
well to bear in mind the wise old saying : 



PROTECTION OF THE BODY. 49 

" If the wind strikes you through a hole, 
Go count your heads and mind your soul." 

The impression that the effect of cold is shown 
chiefly in some disorder of the air-passages is so 
prevalent, that I wish to emphasize the fact that 
the lungs and the air-passages to the lungs are by 
no means as frequently or as seriously affected by 
chill to the surface of the body and to the extremi- 
ties, as are the organs of digestion and the nervous 
system. The nervous system is prostrated, so to 
speak, in its effort to maintain the equilibrium of 
the circulation when disturbed by cold. A chill to 
the surface of the body is a most prolific cause of 
disorder of the digestion, arresting the function of 
the liver, and bringing about the accompanying 
symptoms of loss of appetite, diarrhoea, colic, and 
want of nutrition, all of which very frequently take 
place, without the child showing any of the effects 
of cold by sneezing or coughing. 

The physiological effect of cold is the same, 
whether the individual experiences the sensation or 
not. The nerves of sensation at the surface of the 
skin may be blunted from habitual exposure just as 
the stomach of the drunkard may be tolerant of an 
enormous amount of alcoholic liquor ; but does any 
one imagine that an excessive quantity of alcoholic 



50 HYGIENE OF CHILDHOOD. 

liquor taken into the stomach is not damaging to 
the system ? One may have greater resistance to 
the effect of cold than another, but in the exercise 
of this resistance there is a waste of nerve energy 
and a loss of force which should be held in reserve 
to supply the demands that the system will make 
upon it in the time of illness. 

In one's zeal that the child may be thoroughly 
protected from cold there is the possibility of erring 
on the other side, and that, by being too much and 
too heavily clad, a tenderness and delicacy of the 
body may be induced, with a liability to sudden 
colds from slight changes of temperature. A child 
of from two to four or five years of age, if in good 
health, is, I might say, never quiet during waking 
hours. Its ceaseless motion increases the naturally 
active circulation, and induces free perspiration. 
The clothing, therefore, should be of light but 
warm material, such as will permit the perspiration 
to evaporate freely without the danger of incurring 
a chill. 

Suitable clothing for outdoor wear is also an 
important consideration, especially so for boys dur- 
ing the winter. " Young America " is prone to ex- 
ercise a great deal of independence in dress. He 
imagines that the overcoat is an unnecessary article 



PROTECTION OF THE BODY. 51 

of apparel, and that going without it is the means 
of gaining a tough and hardy constitution. The 
evils resulting from this idea are too frequently 
brought to the notice of the physician. I have 
frequently witnessed a great improvement in a 
boy's health, and known the tendency toward colds 
and snuffles to be broken up, after the boy has been 
compelled to wear an overcoat during the winter 
months. Persistent disuse of it is often the cause 
of catarrhal troubles, pallor of countenance, and the 
want of development of fat. It is equally impor- 
tant that girls should be clad with thick jackets and 
gowns. 

The mother should satisfy herself that her 
daughter's clothing is not too tight about the waist. 
The effect of tight lacing is disastrous enough with 
fully developed women ; the results are far more 
serious with the child. At this period the lungs 
are naturally increasing in size in conformity with 
the development of the rest of the body, and their 
full power of expansion should be permitted, in 
order that sufficient oxygen may be taken into the 
system, and a due amount of waste material carried 
out through the lungs. The full exercise of the 
functions of the liver, stomach, and upper bowels is 
also necessary to healthy nutrition of the body. All 



52 HYGIENE OF CHILDHOOD. 

these duties are interfered with if the clothes are 
worn too tight about the waist. When corsets are 
worn at too early an age, or when laced too tightly, 
they press upon the lower ribs, compressing the 
base of the lungs, and prevent their full expansion. 
The liver and stomach are also compressed, their 
cell-life is interfered with, and the organs them- 
selves become contracted. This retards the pres- 
ent as well as future development of health and 
strength, and constipation and uterine troubles, re- 
sulting from disturbance of the abdominal circula- 
tion and the downward pressure of the bowels, are 
among the probable evils. 

The skirts and under-garments of young girls 
should be supported by shoulder-straps or skirt- 
supporters, in order to avoid undue pressure about 
the abdomen, and the downward pressure into the 
pelvis, that must occur when these garments are 
simply held in place by tight bands about the 
waist. 

A grave mistake is frequently made in night- 
clothing of children. Even careful mothers, who aj> 
preciate the importance of woolen garments during 
the day, will often clothe the child at night in a simple 
cotton night-dress, without the woolen under-shirt. 
This is most unadvisable. During the sleeping- 



PROTECTION OF TEE BODY. 53 

hours the circulation is more feeble, and the vitality 
is lower. The shin requires, therefore, careful pro- 
tection at this time, in order to maintain an equi- 
librium of the circulation. Linen shirts should be 
discarded during the fall, winter, and spring, and 
even during the summer when at the sea- shore, at 
which time the child should wear some kind of 
woolen under-shirt. Very young children may wear 
flannel or canton-flannel combination suits. The in- 
sensible perspiration which is constantly thrown off 
carries with it an amount of waste material which 
is rubbed off the skin and retained in the under- 
flannel or clothing. The under-garments worn dur- 
ing the day, therefore, should be changed at bed- 
time, so that this noxious matter may be destroyed 
or disinfected by exposure to the air. For the same 
reason, also, fresh under-clothing should be put on 
several times a week. 

"When we consider that about one third of an 
adult's life and nearly one half of a young child's 
life are passed in bed and sleep, the immediate sur- 
roundings of the individual during that time, are 
matters of no small consideration. 



54 HYGIENE OF CHILDHOOD. 

IMPORTANCE OF PURE AIR. 

The importance of pure air and the great dan- 
ger of foul air in the house, in its effects upon chil- 
dren, are not always fully appreciated. Pure air 
is as necessary as good food, for the oxygen in 
it is as distinctly an article of nutriment. With- 
out the necessary supply of oxygen a sufficient 
number of blood-corpuscles can not be formed, and 
in consequence the healthy growth of tissue can 
not take place. When, therefore, the air taken 
into the lungs does not contain the full supply of 
oxygen, as in the case where there is defective 
ventilation, the system is deprived of due nutri- 
tion, a starvation of tissue is the result ; develop- 
ment is retarded, and there is a lack of physical 
strength. 

The sense of smell, and the effect that the air 
has upon the ease of breathing and general com- 
fort, are as a rule sufficient guides as to its purity. 
With many individuals, however, this can not be 
relied upon, for their faculty of detecting an impure 
atmosphere is blunted, from their breathing it so 
continuously. If upon entering a house or a room 
there is the slightest odor perceptible, one may feel 
assured that there is insufficient ventilation and that 



IMPORTANCE OF PURE AIR. 55 

the air is vitiated, and therefore detrimental to 
health. 

The sources of air pollution or vitiation in the 
house are defective plumbing, burning of gas, the 
gas given off from defective furnaces and stoves, 
cellars that are damp or that contain rotted wood 
or undue amount of vegetable matter, exhalatious 
from the body and lungs, and lastly house filth. 
The unsanitary condition of the house, permitting 
foul odors from the drains or water-closet to con- 
taminate the air the child breathes, will devitalize 
the system, poison the nerve-centers, and exercise a 
baneful effect upon the growth and health. If the 
air is loaded with decomposing material from drains, 
or is vitiated by want of proper ventilation, the 
child will display all the symptoms manifested by 
children who have poor food and an insufficient 
amount of sleep ; such as pallor of countenance, 
headache, loss of appetite, want of energy, and 
general depression. Breathing impure air is also a 
prolific cause of catarrhal colds and sore throats ; it 
predisposes a child to tonsillitis, bronchitis, and 
pneumonia ; and as a result of lowered vitality 
there is less power of resistance to the contagious 
diseases, such as scarlet fever, diphtheria, etc. The 
air of the nursery or bedroom is frequently ren- 



56 HYGIENE OF CHILDHOOD. 

dered unwholesome by burning too much gas. It 
must be borne in mind that one ordinary gas- 
burner consumes as much oxygen or vitiates as 
much air as five people ; so that, if the gas has 
been burning for any length of time in a sleeping- 
room, fresh air from out of doors should be ad- 
mitted before retiring for the night. So, too, fresh 
air should always be admitted when the nursery has 
been used as a sitting-room or a play-room during 
the afternoon, for the atmosphere becomes polluted 
by the exhalations from the lungs. 

The used-up material thrown out of the system 
through the lungs and from the surface of the body, 
and which consists chiefly of carbonic acid gas and 
organic matter, is a constant source of air pollution. 
The carbonic-acid gas was formerly considered to be 
the most dangerous of air impurities, but we now 
know that the organic matter carried out with the 
breath and with the perspiration is far more deleteri- 
ous. This product is an actual poison of a virulent 
character, as has been shown by the investigations of 
Prof. Brown-Sequard. In condensing the watery 
vapor coming from the human lungs he obtained 
a poisonous liquid capable of producing almost im- 
mediate death. He injected the liquid under the 
skin of a rabbit, and the effect was speedily fatal. 



IMPORTANCE OF PURE AIR. 57 

When the organic poison coming out of the 
lungs is rebreathed, the individual is subjected to a 
process of slow poison, which, although not fatal, is 
steadily undermining the functions of life. 

This organic matter does not long remain in sus- 
pension in the air of the room ; its weight causes a 
large portion to settle upon the floor and furniture, 
and a certain amount adheres to the walls. The 
accumulations of these solid exhalations from the 
lungs and skin, that must necessarily take place in a 
room or house where there is insufficient cleanliness 
or imperfect ventilation, constitute a great part of 
house pollution, or, as I have elsewhere termed it, 
"house filth," and give rise to that peculiar stuffy, 
disagreeable smell so noticeable in some houses. 

Investigation shows that from this organic mat- 
ter are developed minute organisms or low forms of 
fungoid life, and that the number of these organ- 
isms will vary according to the amount of this house 
filth. It has also been demonstrated that the state 
of health of the inmates of the house largely de- 
pends upon the number of these micro-organisms, 
and that in times of epidemics a greater percentage 
of deaths occurs in houses where there is a greater 
amount of this foul air. The term " house filth " is 
perhaps an objectionable one to many, who are not 



58 HYGIENE OF CHILDHOOD. 

aware of the existence of this organic matter, or 
who do not realize the danger that arises from its 
settling upon the furniture, from its being retained 
in mattresses that are seldom picked over or cleaned, 
from its mingling with the dust accumulated be- 
hind and under the furniture, and from remaining 
on the carelessly swept or unwashed floors. Dirty 
carpets become receptacles of organic matter and hot- 
beds for breeding the low organisms. These micro- 
organisms, w T hen taken into the lungs, devitalize the 
system, and are one of the great causes of lowered 
vitality, inducing the symptoms already enumer- 
ated. Careless housekeepers are generators of un- 
healthy households. 

The only way to remove and to keep away this 
organic deposit, which exists wherever human be- 
ings dwell, is by great cleanliness, frequent scrub- 
bing, wiping down the walls, vigorous sweeping, 
shaking the carpets, dusting, and the free admis- 
sion, winter and summer, of the outside air. 

The healthf ulness of the nursery is greatly pro- 
moted by hard -wood floors, covered with rugs, 
which may be taken up frequently and shaken. 
Thorough cleanliness, therefore, as well as ventila- 
tion, is necessary to maintain in the house pure air 
which is imperative for every child to breathe. It 



IMPORTANCE OF PURE AIR. 59 

would seem almost unnecessary to speak of the im- 
portance of opening the windows of the bedroom 
in the morning, but experience proves that it is often 
neglected during the winter months, even in house- 
holds where fair attention is paid to the laws of 
health. The windows of an occupied bedroom 
should be left wide open for a time every morning, 
and the bedclothes thoroughly exposed to the fresh 
air. The impurities in the air are not as quickly 
appreciated when the air is cold as when it is mod- 
erately warm, and, owing to this, a cold room is very 
apt to escape perfect ventilation. 

The night ventilation of the child's bedroom is 
often difficult to accomplish satisfactorily without 
creating a draught. Yet it is a matter of great im- 
port, when we consider that nearly one half of the 
life of a young child is spent in bed. The wide- 
spread delusion that a child should sleep in a cold 
room, and that the windows should be widely open, 
is productive of great harm. If the room is too 
cold, an extra amount of bedclothing is necessary. 
This additional covering, by preventing evaporation, 
retains about the body the exhalations from the 
skin, and the heavy clothing tends to impede free 
breathing as well as to prevent such a peaceful and 
restful sleep as when the covering is light. If the 



60 HYGIENE OF CHILDHOOD. 

covering is too thick, the child after falling asleep 
is very apt to break out into a perspiration. This 
creates a restlessness, the bedclothes are partially 
thrown off, exposing the surface of the body to the 
cold night air, and to the risk of those evils to which 
I have already alluded when children are too thinly 
clad. In heavy sleep the sensation of cold is not 
experienced, but the injurious effects follow never- 
theless. The temperature of the room, therefore, 
should not be cold enough to necessitate heavy cov- 
ering. Cotton sheets and light blankets are the 
only covering suitable for a child at night. Com- 
forters of down or cotton do not permit the ready 
evaporation of the insensible perspiration, and are 
not, therefore, as healthful as blankets. During 
very cold weather it is desirable to ventilate the 
bedroom at night through another room, or by 
means of a door leading into the hall, where a win- 
dow may be left open, so that the air may be tem- 
pered before reaching the room. During moderate 
weather the bedroom window may be left open a 
short distance from the top. Some means should 
always be provided for the exit of foul and the en- 
trance of pure air. 

It is impossible to prescribe the details of venti- 
lation for the bedroom, for the directions must natu- 



IMPORTANCE OF PURE AIR. 61 

rally vary according to the size and position of the 
room and the condition of the atmospheric tempera- 
ture. While calling attention to the very great im- 
portance of pure air in the bedroom, I only desire to 
emphasize the danger of too cold a room. I am 
aware that some physicians advocate sleeping in 
very cold rooms. I fail, however, to see the neces- 
sity or reason, from a hygienic standpoint, for so 
doing. If toughening the child is the motive, it js 
certainly a mistaken one ; if fresh air is the object, 
this should be accomplished if possible without low- 
ering the temperature too much. The temperature 
in the sleeping-room of a child over three years of 
age, evincing no sign of lung trouble, should be be- 
tween 50° and 60° Fahr. With this degree of tem- 
perature, pure air in the room, and not too heavy 
bed-covering, the sleeper will awaken in the morn- 
ing, after a restful sleep, without any injury to 
health. 

Many devices are resorted to for allowing fresh 
air to enter through a window without creating a 
draught ; only two of which, on account of the ease 
of application and efficacy, I will mention. 

The one I would especially recommend is as fol- 
lows : A frame should be made about twelve inches 
high, and of a width sufficient to fit in the window- 



62 HYGIENE OF CHILDHOOD. 

frame ; on this should be tacked coarse muslin, or, 
if preferred, loosely woven colored cloth. The 
upper sash is then lowered sufficiently to insert the 
prepared frame at the top. This device is largely 
used in hospitals, and permits fresh air to come in 
without creating a draught, and also excludes the 
dust. 

The other method recommended is the placing 
a, strip of wood six inches broad under the whole 
length of the lower sash, which, by being raised, 
permits a current of air to enter between it and the 
upper sash, and, when the window-shade is raised, 
directs the current upward toward the ceiling and 
lessens the danger of air blowing upon those who 
may be in the room. 

An open fireplace, even without a fire, is a great 
aid in promoting good ventilation, and is desirable 
to have in every bed-room. Where the sleeping- 
room is small, without a fireplace, it is impossible 
to secure pure air in it throughout the night unless 
a window or door is open. If the choice lies be- 
tween having the bedroom air of moderate temper- 
ature rendered impure by bad ventilation, and cold 
with good ventilation, it is far better to have the air 
cold and pure, and covering the sleeper with the 
objectionable heavy clothing. 



IMPORTANCE OF PURE AIR. 63 

The sudden and great change, after breathing 
during the day the overheated air that is found in 
most houses, to the very cold air inhaled at night 
while sleeping, when the circulation and vitality are 
lowered, induces a catarrhal condition or a conges- 
tion of the mucous surfaces of the air-passages. 

When the seat of this catarrh is in the mucous 
membrane of the nose, free respiration through the 
nose is interfered with, and as a result the child is 
compelled to breathe through the mouth. I wish 
here to urge the great importance of breathing 
through the nose rather than through the mouth. 
The configuration of the inner portion of the nose 
is such that a large amount of mucous surface is 
exposed. This warms the air passing over it, and 
protects the pulmonary circulation from the shock 
that occurs when cold air is breathed directly into 
the lungs through the mouth. The mucous mem- 
brane covering the irregular turbinated bones in the 
nose performs another important duty : it collects 
and retains on its moist surface a large amount of 
the organic and inorganic matter floating in the air, 
and thus prevents this material finding entrance into 
the lungs, where its presence is a source of irritation. 
Moreover, the air in its passage through the nose 
absorbs more or less moisture, and is thereby ren- 



64 HYGIENE OF CHILDHOOD. 

dered more acceptable and less irritating to the pul- 
monary organs. Thus we see that the nose per- 
forms a threefold office, viz., filtering by removing 
floating particles, warming the air, and giving 
moisture to the air. It acts as a vestibule does to 
a house, preventing a sudden rush of cold, dirty air 
into the more refined apartments within. 

Understanding now the important duties per- 
formed by the nose, the injurious consequences that 
take place when there is a hindrance to the full ac- 
complishment of its functions can be set forth. In 
order that a sufficient amount of air may enter the 
lungs for the purpose of purifying the blood, the 
caliber of the passage through which the air passes 
in must be of proper dimensions, consequently it is 
highly important that there should be no thickening 
of the nasal mucous membrane to diminish the cali- 
ber of the nasal passage. If the child breathes 
through the nose with a contracted passage, less 
oxygen can find entrance to the lungs than Nature 
intended, and there results an imperfect purification 
of the blood. A retention of the impurities affects 
the general health, in the same manner as already 
spoken of when impure air is breathed. When the 
air is taken in through the mouth, its low tempera- 
ture, insufficiently supplied with moisture, and hold- 



IMPORTANCE OF PURE AIR. 65 

ing in suspension an amount of organic and inor- 
ganic matter, has more or less damaging influence 
upon the pharynx or back part of the mouth and 
the lungs. The mucous surface of this portion of 
the breathing apparatus is not intended to with- 
stand the harsh influences of the direct air, and, 
when this takes place, there results an unhealthy 
or catarrhal condition of some portion of the mu- 
cous membrane, and the individual is predis- 
posed to acute or chronic pharyngitis, laryngitis, 
bronchitis, pulmonary congestion, and more readily 
falls a victim to consumption. A mouth-breather 
is rarely a strong, healthy being. Mouth-breathing 
often becomes a habit, perhaps started by an influ- 
enzal cold, and can be overcome in many instances 
when there is no hypertrophy of the mucous sur- 
face, by constantly calling the attention of the child 
to breathing through the nose. One of the chief 
causes for inducing the habit of mouth-breathing, 
aside from that directly caused by thickened mu- 
cous membrane of the nose, is the impure, over- 
heated house air. 

The North American Indians have so clearly 
appreciated in a practical way the benefits of 
breathing through the nose, that they early habitu- 
ate their children to its practice. The Indian 

5 



06 HYGIENE OF CHILDHOOD. 

woman watches with care the manner of breathing 
of her offspring. If the mouth is open, she will 
gently close the lips, and when necessary even 
bandage them in order to compel breathing through 
the nose. If we, as a civilized people, would but 
enforce the practice of the Indians, and take the 
pains to cultivate this habit with our children, 
guarding them from everything which may devel- 
op nasal catarrh, an important factor would be con- 
tributed to the more perfect development of our 
offspring. 

The child reared under the conditions imposed 
by our modern manner of living becomes a more 
sensitive creature and is more easily affected by at- 
mospheric changes and cold air; consequently, he 
can not, while asleep, breathe with impunity the 
cold night air, as can the Indian child, who has an 
inherited vigor, and leads a mere animal existence. 
Civilization and refinement, while bringing comfort 
and pleasure to body and mind, at the same time 
impose certain penalties, and necessitate a much 
stricter observance of the laws of health. 

The benefits to health, accruing from free ven- 
tilation and pure air, are constantly exemplified 
in cases where animals are herded together. Sta- 
tistics from the stables of the French army show 



IMPORTANCE OF PURE AIR. 67 

a reduction of mortality among horses of from 
one hundred and eighty per thousand horses to 
twenty per thousand after free ventilation had 
been introduced.* The same ratio of increased 
health has also been shown in factories and work- 
shops where free ventilation and cleanliness are 
enforced. Dr. Parkes gives another remarkable 
instance illustrating the benefit of good ventila- 
tion. He mentions the fact that in the badly venti- 
lated prison of Leopoldstadt, Vienna, 51-4 per 
thousand prisoners died from consumption ; while 
in the well-ventilated house of correction, in the 
same city, the mortality from the same disease was 
7*9 per thousand. This statement should arrest the 
attention of those in whom there is any hereditary 
tendency toward pulmonary trouble, and impress 
upon them the great necessity of having good house 
ventilation. 

To preserve the purity of air in the household, 
four requirements must be fulfilled : First, the ad- 
mission of fresh air from out-of-doors, to take the 
place of the air which is constantly being vitiated 
wherever animal life exists. Second, through clean- 
liness, to remove from the furniture and floors the 

* " Manual of Practical Hygiene," by E. A. Parkes, M. D., W. 
Wood & Co., vol. I, p. 146. 



68 HYGIENE OF CHILDHOOD. 

organic matter which is constantly thrown off from 
the lungs and skin. Third, frequent inspection of 
plumbing. Fourth, a cellar free from all dampness, 
rotting wood, and everything that may be in a state 
of decomposition. We might add another requisite, 
viz., to see that stoves and furnaces do not discharge 
that most dangerous product of combustion, car- 
bonic-oxide gas, into the rooms. If there is a crack 
in the furnace, or the stove-damper is turned off 
too much, this gas is discharged into the house, 
and exerts a most pernicious effect upon all who 
breathe it. 

Having already commented on the importance 
of the admission of fresh air, and cleanliness, I will 
briefly allude to the other requirements. 

The plumbing of a house should be so located 
that it can be thoroughly inspected without disturb- 
ing the plaster and wood-work, and it is certainly 
advisable to have it inspected every few years. 
Sewer-gas has a corroding effect upon lead, so that 
a lead pipe that is sound one year may be perfo- 
rated with holes a year later. In modern plumbing 
very little lead pipe is used, but there are small sec- 
tions of this pipe employed in the average house. It 
is a great mistake to rely upon the sense of smell, in 
detecting the presence of cracks and openings into 



IMPORTANCE OF PURE AIR. 69 

soil-pipes, for some of the most dangerous emana- 
tions from these pipes are scarcely perceptible by 
their odor. The micro-organisms, arising from the 
decomposing organic matter adhering to the in- 
terior walls of the pipe, are not particularly offen- 
sive, and yet they are more dangerous in their effect 
upon the human system than the sewer-gases. The 
germs of typhoid fever, scarlet fever, diphtheria, and 
other contagious diseases, may find entrance into 
the house through a crack or fissure in the pipe that 
allows the entrance of sewer-gas. 

The fourth indispensable condition to be ob- 
served — i. e., that cellar air be free from dampness 
and germs of decomposition — is one that is not gen- 
erally understood or appreciated, even by those who 
have a fair knowledge of sanitary matters. During 
the cold weather, when the doors and windows are 
closed, the air from the lower floors and cellar is 
drawn upward, by the current of heated air above. 
This assertion may be verified by pouring on the 
cellar floor a small quantity of oil of peppermint, 
when the odor will be detected in a few minutes 
throughout the house. "Wherever the presence of 
the peppermint is detected, there impure cellar air, 
if such exist, will find entrance. 

To maintain pure air in the cellar, it must be 



70 HYGIENE OF CHILDHOOD. 

free from all dampness, free from all rotted wood, 
and from all material which is undergoing decompo- 
sition. Wherever there is confined dampness, there 
will be found low forms of vegetable molds, which, 
although perhaps not visible to the naked eye, are 
easily shown to exist by the aid of the microscope. 
These low vegetable organisms, drawn by the 
heated air of the house to the upper floors, and 
inhaled by the inmates, are a prolific cause of the 
general malaise and lowered vitality that so many 
suffer from while living in houses with unsanitary 
and especially damp cellars. They also give rise to 
illnesses simulating malaria, and cause quinine to be 
used so freely in many households. Sore throats, 
bronchial troubles, and a condition of the system 
calling for tonics, are also of frequent occurrence in 
houses 'with damp cellars. Let me urge all those 
in whose families there is a taint of consumption 
to be especially watchful that the cellar is free from 
all dampness, for it has been definitely proved that 
the death rate from consumption is greatly dimin- 
ished if the subsoil under and about the house is per- 
fectly dry. In a report of an investigation of drain- 
age of one hundred and twenty-eight towns in Mas- 
sachusetts, Dr. Windsor remarks, in regard to the 
influence of a damp soil upon the health of persons 



IMPORTANCE OF PURE AIR. 71 

living over it, that " the class of diseases most fre- 
quently noted in connection with damp cellars are 
inflammatory diseases of the respiratory organs, es- 
pecially bronchitis. Next in order of frequency 
comes rheumatism, more particularly of the sub- 
acute order. Phthisis, pneumonia, and wasting 
chronic perversions of digestion, are also- found 
by many of our correspondents to be common in 
houses with such cellars ; also a lessened power of 
resistance to all diseases when contracted. No ob- 
server can doubt that a large amount of preventible 
disease is caused by damp cellars." * 

Every parent should realize the vital importance 
of pure air for a growing child, and should endeavor 
to keep the air in the dwelling as pure as possible, 
especially as it is not a difficult object to secure. It 
only necessitates careful and intelligent supervision 
of the requirements mentioned, and, when these are 
observed, the reward will be apparent in the in- 
creased vigor and health of the child. 

*" Seventh Annual Report of the Massachusetts Board of 
Health," p. 227. 



72 HYGIENE OF CHILDHOOD. 

EXERCISE. 

A full amount of exercise in the open air is one 
of Nature's requirements for healthy development 
and for the maintenance of a good state of health. 
Every child, therefore, should have several hours 
set apart daily for this purpose, that its energy may 
find free vent in all outdoor sports. Instinct leads 
a child to run, climb, jump, and freely use the 
voice. All this strengthens the muscles and liga- 
ments, enlarges the breadth of the chest, improves 
the digestion, sharpens the appetite, and keeps the 
functions of the body in a healthy condition ; it in- 
creases the activity of the circulation, thereby pro- 
moting the exhalations from the skin and lungs, 
thus eliminating from the system the used-up or 
waste material floating in the blood, and rendering 
the mind more active. "When the weather is in- 
clement, the recreation and play should be indoors, 
but out-of-doors when the weather permits; for, 
added to the exercise, the child not only breathes 
pure air, but derives benefit from the life-giving 
power of sunshine. The misshapen, narrow, and 
flat chest so often found among residents of cities is 
largely the result of insufficient exercise of the arms 
and chest during early youth. This narrowing of 



EXERCISE. 73 

the chest reduces space for the lungs, and interferes 
with their full development. With small or imper- 
fectly developed lungs the working of the whole or- 
ganism is affected, for it is through the lungs that 
oxygen, which is so necessary for the proper trans- 
formation of food into nutriment, finds entrance, 
and here also that a large portion of the waste 
material is thrown off. It is impossible, therefore, 
to enjoy perfect health while so important an organ 
is compressed. One is more apt to fall a victim to 
phthisis and acute pulmonary diseases when the 
lungs are cramped. 

During the period of youth very much can be 
done to guard against a contracted chest, by the 
daily exercise of the arms, avoiding a stooping 
posture while sitting or walking, and by wearing 
loose and easy clothing, so that there can be no 
compression of the chest- walls. 

Light calisthenics, now practiced in many Kin- 
dergarten schools, are an invaluable aid in assisting 
the development of the chest. If the same plan of 
combining physical and mental training could be 
carried on throughout the whole school-life it would 
be productive of an incalculable amount of good for 
many children, especially those who are delicate and 
those of a more studious turn of mind, who obtain 



74 HYGIENE OF CHILDHOOD. 

very little exercise except that received in walking 
to and from school. 

All games calling for the use of the arms should 
be encouraged. The hoop, battledore and shuttle- 
cock, bean-bags, ball-playing for boys, and the par- 
allel bar for older children, all tend to develop the 
chest, and can be used during the winter as well as 
the summer. The use of the skipping-rope, in 
moderation, may be permitted for little girls, but 
should be forbidden as they approach the years of 
puberty. During the summer months, lawn tennis 
affords admirable exercise, and is most beneficial for 
girls. It calls them out into the fresh air, brings 
into play all the muscles of the arms, loins, and legs, 
and develops the chest. The game has sometimes 
been condemned for girls — unjustly so, it seems to 
me. Because some few, who have more spirit than 
common sense and physical strength, have played 
to excess and thereby injured themselves, the game 
should not be condemned, any more than riding or 
any other exercise. When played in moderation, 
under certain restrictions, it is most valuable as an 
aid to muscular development. All clothing worn 
while playing this game should be light and loose, 
especially the corsets, which should have few bones, 
and should yield readily to any movement of the 



EXERCISE. 75 

body. The game should never be played at any 
time during the period of menstruation. My expe- 
rience has shown that, when any harmful results 
have followed from the game, there have been in- 
dications of previous pelvic irritation, or the game 
has been played during menstruation, or while wear- 
ing tight corsets, or while the health has been poor. 
Certainly, the benefits derived from the game coun- 
terbalance a hundred-fold the harm. 

With children who are delicate by inheritance, 
special attention should be paid to the development 
of the chest. Their muscular tissues being feeble 
and the bony framework abnormally soft, there is 
great danger that the chest-walls may be bent for- 
ward, causing a compression of the thoracic cavity. 
These children should be encouraged in the exercise 
of all the youthful sports, care being taken naturally 
that they do not overtax their strength. In running 
and playing the lungs are more fully inflated, thus 
helping to increase their size. A greater quantity of 
the oxygen of the air enters the circulation, and a 
larger amount of waste matter is thrown off. 

The dainty little creature who is praised for act- 
ing " like a little gentleman " or " a little lady," who 
is reproved for a particle of dirt on its clothing, and 
compelled to walk demurely, taking hold cf the at- 



76 HYGIENE OF CHILDHOOD. 

tendant's hand, is generally a subject for rhubarb 
and soda, calomel, ipecac, iron, and other drugs 
whose use becomes necessary to keep the liver, 
lungs, and bowels in good condition, thus supplant- 
iug Nature's medicine, exercise, by the concoctions 
of the apothecary. 

An inactive, indoor life for the young lowers the 
vitality, retards the full development of the muscles, 
induces a softness and delicacy of all the tissues, 
and lessens the power of resisting cold and diseases 
of all kinds. 

Housing children during the winter weather, as 
a precaution against their taking cold, is a very 
great mistake. Very few colds are contracted in the 
open air, if the feet, limbs, and body are sufficiently 
protected in the manner already indicated, and if 
the children are permitted to follow out their own 
inclinations of running, skipping, and having free 
motion of the arms, and are not exposed for too long 
a time to the cold. When, however, they are com- 
pelled to walk like " little gentlemen and ladies," 
even when bundled in furs, the body soon becomes 
chilled if the weather is very cold, and some disturb- 
ance of the system follows. Children should be ac- 
customed to daily exercise in the open air in all 
weathers, unless, of course, it is very stormy or the 



EXERCISE. 77 

cold is severe, and even when delicate they should 
not be deprived of the tonic effect of outdoor air, 
and of strengthening the muscles by exercise in it. 
The first effect of cold air upon the system is a tonic, 
as may be seen by the bright color on the cheeks, 
and a feeling of exhilaration after a walk on a crisp 
day in autumn. Prolonged exposure to cold, on the 
other hand, is very depressing ; delicate children, 
therefore, should not remain too long out-of-doors if 
the weather is severe, or if it is very windy ; for high 
winds, if cool, rapidly abstract the animal heat, and 
are also depressing. If a child is chilled or cold, it 
should instantly be brought into the house to be 
warmed and sent out again, taking the fresh air and 
outdoor exercise in installments, as it were, instead 
of all at once. Never permit a child to remain out- 
of-doors when crying from cold. 

Children will frequently complain of pain in the 
legs and arms, which prevents them from exercising 
sufficiently. Their parents are often at a loss to de- 
termine the extent and true character of the pain, 
its transient nature deceiving and often leading 
them to donbt its existence, thereby causing much 
unnecessary suffering, owing to a misconception of 
the cause ; and, when the pain is admitted, it is 
looked upon as a necessary accompaniment of child- 



78 HYGIENE OF CHILDHOOD. 

hood. These so-called " growing pains " — a mis- 
nomer — are caused either by fatigue of the mus- 
cles — the result of over-exertion — or by some strain 
upon the tender articular surfaces, or are brought 
about by cold, inducing a species of muscular rheu- 
matism. Children of sedentary habits, who are not 
protected sufficiently by flannels, and also those of 
delicate organization possessing more energy than 
vigor, are the chief sufferers from these pains. In 
every case, however, these pains can and should be 
promptly relieved, in the one instance by warmer 
clothing, in the other by carefully guarding against 
too violent and prolonged exercise. 

The brightest and sunniest room in the house 
should be given to the children for their play-room ; 
this is especially necessary during the winter 
months, when they can not spend many hours out- 
of-doors. Sunlight is as essential to the health of 
children as it is to plants. One who has attempted 
to grow plants in the house in winter full well 
knows the importance of placing them where the 
sun can shine upon them. Children living in sun- 
less rooms are not only injured physically, but 
are apt to become fretful and irritable, while 
sunlight generally brings brightness and content- 
ment. 



EXERCISE. 79 

I wish here to protest against that pernicious 
habit of attempting to " toughen" a child by means 
of light clothing, by cold sleeping-rooms in winter, 
bathing in too cold water, and other harmful pro- 
cesses, that mistaken mothers adopt in the harden- 
ing of their children. Do not be guided by enthu- 
siasts on the subject of cold, but profit by the ad- 
vice of physicians, whose study and experience en- 
able them to give proper advice in this matter. 
The only way to harden a child — by which is meant 
rendering him less susceptible to the effect of cold, 
and giving him strength and vigor of body — is by 
rigid adherence to the laws of health ; that is, pro- 
viding a sufficient amount of clothing, plenty of 
outdoor exercise, pure air to breathe, simple and 
good food, with ample amount of sleep. I have in 
mind two school companions, who were naturally 
delicate, and wished to harden themselves, that they 
might do as other boys. The result of their harden- 
ing, which consisted in discarding overcoats, sleeping 
with windows wide open in winter, and other fool- 
ish habits, was that they died from consumption in 
early manhood. This is the fate that befalls many. 
Do not suppose that all children can be brought up 
under the same rules. Judgment and common 
sense must be brought to bear in deciding upon 



80 HYGIENE OF CHILDHOOD. 

questions of dress and of exercise in individual 
cases. Cast-iron rules will not apply. 

SLEEP. 

Dr. Hammond, in his valuable treatise on " Sleep 
and its Derangements," says : " The state of gen- 
eral repose which accompanies sleep is of especial 
value to the organism in allowing the nutrition of 
the nervous tissues to go on at a greater rate than 
its destructive metamorphosis. The same effect is, 
of course, produced upon the other structures of 
the body, but, as regards them, this is not of so 
much importance, for while we are awake they all 
obtain a not inconsiderable amount of rest. Even 
those actions which are most continuous, such as 
respiration and pulsation of the heart, have distinct 
periods of suspension. Thus, after the contraction 
and dilation of the auricles and ventricles of the 
heart, there is an interval during which the organ 
is at rest. This amounts to one fourth of the time 
requisite to make one pulsation and begin another. 
During six hours of the twenty-four the heart is 7 
therefore, in a state of complete repose. If- we di- 
vide the respiratory act into three equal parts, one 
will be occupied in inspiration, one in expiration, 
and the other by a period of quiescence. During 



SLEEP. 81 

eight hours of the day, therefore, the muscles of 
respiration and the lungs are inactive. And so 
with the several glands. Each has its time for rest. 
And of the voluntary muscles, none — even during 
our most untiring waking moments — are kept in 
continued action. . . . 

" But for the brain there is no rest except dur- 
ing sleep. So long as an individual is awake, there 
is not a single second of his life during which his 
brain is altogether inactive. ... Its substance is 
consumed by every thought, by every action of the 
will, by every sound that is heard, by every object 
that is seen, by every substance that is touched, by 
every odor that is smelled, by every painful or 
pleasurable sensation ; and so each instant of our 
lives witnesses the decay of some portion of its 
mass, and the formation of new material to take its 
place. . . . 

" The necessity for sleep is due to the fact that 
during our waking moments the formation of the 
new substance does not go on as rapidly as the decay 
of the old. The state of comparative repose which 
attends upon this condition allows the balance to 
be restored, and hence the feeling of freshness 
and rejuvenation we experience after a sound and 
healthy sleep." 



82 EYOIENE OF CHILDHOOD. 

The necessity of sleep during childhood is vastly 
greater than during adult life, for during the former 
period there is a proportionately greater destruction 
of nerve-tissue, as the result of the ceaseless activity 
of the child ; and longer duration of sleep is requi- 
site, to allow time for the reparation of the substance 
destroyed, and the addition of new matter for the 
growth and development of the brain and nervous 
organization. The child of six or seven years of 
age requires at least eleven or twelve hours night 
sleep, and should be in bed by half-past 6 or 7 p. m. 
The duration of sleep after the seventh year may 
be gradually diminished up to the period of puberty, 
when nine or ten hours will be sufficient. A nap 
in the middle of the day is desirable for all young 
children, and quite important for a child under four 
years of age. It gives the nervous system a rest, 
and makes a break in the nerve excitability that 
always exists at an early age. If the noon nap is 
not prolonged over an hour or an hour and a half, it 
will rarely have any effect upon the duration of the 
night sleep ; on the contrary, it will frequently be the 
means of aiding good sleep at this time, by checking 
that excitability of the brain which so often prevents 
children from quickly falling asleep after retiring. 

The symptoms resulting from too little sleep are 



SLEEP. 83 

nervous irritability, restlessness, loss of flesh, and a 
delicacy of digestion. Many will exhibit a dull- 
ness, pallor of the face, and a disinclination to play. 
When from any circumstances a child has acquired 
the habit of lying awake for a long time after going 
to bed, a full warm bath, or even a warm foot-bath, 
given just before retiring, will be of benefit. The 
suggestions to be mentioned hereafter regarding the 
avoidance of mental work or excitement after sup- 
per, all of which will prevent undue brain activity, 
and soon restore the habit of quiet, restful sleep, 
should also be noted. 

In the era in which w T e live, the necessity of 
plenty of sleep for the youthful brain is of vital 
importance. The parents of many of the present 
generation of children are of an exceedingly nervous 
temperament, and we naturally look for a highly 
wrought nervous organization in their offspring. 
For this class especially, and for those in whose 
family there is consumption, or a tendency toward 
delicacy of the body, it becomes a matter of the 
highest importance that the child should have an 
ample amount of sleep ; when this requirement is 
not fulfilled, there is far greater likelihood of the 
development of the hereditary disease, while there 
is less resistance to illness of all kinds. 



84 HYGIENE OF CHILDHOOD. 

Abundance of sleep is very essential during the 
maturing years, to enable the nervous system to 
acquire firmness and vigor. Insufficient amount of 
sleep often results in smallness of stature or stunted 
growth, and in insanity in later years. I have said 
that the nerve system needs a certain amount of 
rest, in order to direct the building up and the 
repairing of wastes. If this full amount of rest is 
not obtained, the building-up process is likely to be 
interfered with, or, if the nerve-force is successful 
in both building up and repairing the wastes, it is 
apt to suffer a collapse in after-years, like the boiler 
in a factory, that may be of service for many years, 
under a reasonable amount of work, but which, when 
run under high pressure, w T ith roaring fires, very 
soon gives out, and explosion ensues. 

The hour immediately preceding bedtime should 
be spent quietly, in order to relieve the nervous sys- 
tem from all excitement. Eomping and excited play 
that young children frequently indulge in, and the 
exciting tales of fiction that older children pore over 
just before the hour of bedtime, are very detrimental 
and should never be permitted. They stimulate the 
circulation of the brain, and very frequently cause 
dreams, " night terrors," restlessness, disturbed and 
insufficient sleep. Children may amuse themselves 



SLEEP. 85 

with light games, knitting, and crochet, or they 
may be read aloud to, provided the book is not 
exciting, but anything bordering on excitement or 
brain-work should be avoided. With the dreamer, 
the nervous system does not obtain its proper rest, 
though the body is asleep, for there is as much 
expenditure of nerve-force during the moments 
or hours of dreaming as there would be if the 
child were awake and undergoing the same mental 
thoughts and excitement. Therefore, it is of the 
greatest importance, in order that the full nerve- 
rest may be obtained during the sleej^ing hours, 
so to conduct the child's general hygiene that the 
dreams do not occur. Frightening stories told by 
nurses, with the idea of enforcing obedience, are 
frequently the direct cause of the night's terrors 
and dreams of childhood. 

I have already reminded the reader of the fact 
that one half to one third of a child's life is spent in 
bed, and have incidentally alluded to the great im- 
portance of the individual surroundings during this 
period. It is perhaps wise, in considering this sec- 
tion, to give a resume of the conditions favorable to 
a healthy sleep. These may be briefly stated as fol- 
lows : The bedroom should be well ventilated, in 
order to maintain pure air, which should not be 



83 HYGIENE OF CHILDHOOD. 

overheated or too cold; the personal clothing should 
be loose and free, to permit good circulation; the 
bed-covering should not be too warm nor too heavy, 
for heavy covering embarrasses respiration and cre- 
ates restlessness ; the sleeper should breathe through 
the nose, and keep the mouth shut; indigestible 
food should be avoided late in the day ; those who 
are not strong will sleep better by taking some light, 
digestible food just at bedtime ; there should be an 
avoidance of mental excitement or activity during 
the hour preceding that of retiring. 



EEGULAEITY OF THE BOWELS. 

The removal from the system of used-up or 
waste material is accomplished through four chan- 
nels, viz., the lungs, the skin, the bowels, and the 
kidneys ; and for the preservation of health it is 
of the highest importance that all these means of 
exit should be kept in perfect condition. If any 
one of these excretory organs fails to do its share 
of elimination, its duty must fall upon the others, 
in which case they are overtaxed, and in turn are 
disturbed in their functions. At the same time the 
noxious matter, which should pass out, is retained 
in the system too long, producing self -poisoning. 



REGULARITY OF THE BOWELS. 87 

The elimination from the lungs and kidneys 
generally takes place in a healthy manner during 
childhood ; on the other hand, there is a liability to 
imperfect performance of the duty required of the 
bowels and skin, and of fostering a chronic, morbid 
condition of these channels of elimination. Many 
parents and nurses are not aware of the misery and 
discomfort, to say nothing of ill health, that they 
are responsible for, by neglecting to impress upon 
the child the extreme necessity of a daily action 
from the bowels. The statement of a young child 
should not be relied upon, but it should be the duty 
of the mother or nurse to see that the act is daily 
accomplished. The child, having grown older and 
having reached the period of school-life, is very apt 
to hasten out to play or to school, and to neglect 
the call of Nature. If Nature's calls are frequently 
neglected, she will after a while cease to convey to 
the brain the impression that the bowels should be 
evacuated, and we are then forced to give a stimu- 
lant or excitant, in the form of medicine, to insure 
an action. 

Aside from the neglect above mentioned, the 
causes which bring about constipation are, either 
insufficient amount of vegetable and coarse farina- 
ceous food, a defective nerve-force, or general phys- 



88 HYGIENE OF CHILDHOOD. 

ical weakness, with deficiency of intestinal secretion, 
want of daily exercise, or intestinal catarrh. In the 
effort to establish regularity, the immediate canse of 
the constipation should be ascertained, and the de- 
fect remedied, in preference to placing dependence 
on medicine. Reliance upon medicines or injec- 
tions should be carefully guarded against, for, if 
the habit be once formed, there is great likelihood 
of its being continued throughout life. Constipa- 
tion with young children is often due to a mild 
intestinal catarrh, which is induced by the impres- 
sion of cold upon the surface of the body conse- 
quent upon scanty clothing and bare legs. The slimy 
mucus which is excreted in this catarrhal state 
covers the feculent material and thereby diminishes 
the natural stimulation of the peristaltic action, and 
favors an accumulation of the fasces. The remedy 
for constijjation from this cause is to be found in 
extra warmth and protection to the body. 

Neglect in establishing regular daily action of 
the bowels leads to great discomfort in after-life ; 
aside from this, there is a vitiation of the system, a 
self-poisoning, an absorption into the blood of the 
gases and other obnoxious matters. Headache, las- 
situde, impairment of memory resulting from poi- 
soning of the nervous system, indigestion, muddy 



REGULARITY OF TEE BOWELS. 89 

complexion, pimples, and bad breath, all follow. 
The child becomes dull or stupid, and is then pun- 
ished most unjustly for a mental condition arising 
from the inattention of others to his physical condi- 
tion. Constipation is a prolific cause of dyspepsia 
and the attendant evils to which the child will be 
subjected until regularity of the bowels is estab- 
lished. Not only should the habit of evacuating the 
bowels at a definite time of the day be taught, but 
a sufficient time should be allowed to permit the 
complete accomplishment of the movement, for, 
when there is a torpid condition of the bowels, too 
frequently the child does not remain seated long 
enough to force downward the feculent matter ; and, 
becoming impatient at the delay, he hastens out 
without accomplishing the act, thus increasing the 
constipated habit and creating a call for medicine. 

The peristaltic action of the intestine is stimu- 
lated by food containing a good deal of cellular 
structure or waste material, such as rye bread and 
oatmeal, also fruit of an acid nature. Baked apples 
or stewed fruit, also prunes, are excellent at the last 
meal of the day. When fresh ripe fruit can not be 
obtained, an orange or scraped apple during the day 
promotes the intestinal secretions and action from 
the bowels, and can be given to the youngest child. 



90 HYGIENE OF CHILDHOOD. 

Much benefit is derived from deep kneading of the 
bowels, especially on the left side. In some instances 
it is necessary to resort to medicines ; in such cases 
guidance should be sought from the physician. 



CAEE OF THE SKIN. 

I have already alluded to the necessity of pro- 
tecting the skin from exposure to cold or from a 
sudden chill, in order that its important function of 
eliminating from the body its share of waste mate- 
rial may not be interfered with. I have stated that, 
when this duty is interfered with, the refuse matter 
is retained in the system longer than necessary, 
a self-poisoning is produced, and, in passing out 
through the other channels of elimination, the 
lungs, the bowels, and the kidneys, these organs be- 
come overtaxed and irritated, causing a predisposi- 
tion to disease. It is evidently, therefore, of the 
highest importance that the skin should be kept in 
as perfect a condition of health as possible. To 
this end two conditions must be fulfilled : its cir- 
culation must be maintained in an active condition 
by sufficient clothing, and the unwholesome mate- 
rial which is constantly thrown out, through millions 
of glands in the skin, must be removed by frequent 



CARE OF TEE SKIK 91 

bathing and friction. The danger was startlingly 
demonstrated of interfering with the eliminative 
function of the skin, and a signal proof of the im- 
portant part which it plays in the maintenance of 
health was afforded, in the w T ell-known instance of 
the "gilded boy," at one of the carnivals in Flor- 
ence during the fifteenth century. The unfortu- 
nate child, in order to represent the dawn of the 
golden age, was covered from head to foot with 
gold foil. This covering completely closed the 
openings of the excretory glands of the skin, and 
caused a retention of the refuse matter which 
should have passed out. The result was the child's 
death within two days. 

When the skin is rendered inactive, through in- 
sufficient covering, an injurious effect upon the 
system follows, differing only in degree, as in the 
case of the "gilded boy." As the life of the gilded 
boy was sacrificed to the desire for show, so many 
mothers, through their desire to beautify their 
infants and children, by dressing them in short 
socks, with arms thinly covered, and often without 
flannels, are as surely impairing their health, if not 
actually and slowly putting their offspring to death 
by a fatal disregard of the law of health that re- 
quires full activity of the glands of the skin. 



92 HYGIENE OF CHILDHOOD. 

Stereotyped rules of guiding the life of a child 
from infancy to maturity cause many a little one to 
fall by the wayside. While certain fixed principles 
for guidance may be established, the minutiae must 
vary according to age, temperament, and vigor of 
health. This statement applies with especial force 
to the bath. Judgment and common sense must be 
exercised in this apparently simple duty, for one 
child may be benefited by a method of bathing that 
would exert a positively injurious effect upon an- 
other, 

Among the ignorant, filth of person is as com- 
mon as the filth of their habitations, and ability to 
bring about reform in either case is almost a hope- 
less task On the other hand, among the intelli- 
gent, the neglect of free ablution is not great ; but 
there is danger, however, in its abuse. Like all 
good things the bath is often a powerful agent for 
evil as well as for good. Unless used intelligently, 
both warm and cold baths may exert a beneficial or 
detrimental effect upon the system, according to the 
method and frequency of giving them, and the con- 
dition of the child. 

The warm bath benefits by directly stimulating 
the cutaneous circulation, and increasing the activity 
of the perspiratory glands. Calling the circulation 



CARE OF THE SKIN. 93 

to the surface necessarily diminishes the supply 
to the internal organs, and consequently affects the 
activity of their secretions. If too long a time is 
occupied in giving the bath, or it is too frequent, 
general lassitude is very apt to ensue. 

The immediate effect of cold water upon the 
skin is to drive the circulation to the inner organs 
of the body ; then, by its impression upon the nerve- 
centers, there takes place the excitement of reaction, 
which soon restores the superficial circulation in 
redoubled force, as is shown by the ruddy appear- 
ance and glow of the surface. If the circulation is 
sluggish, the nervous force weak, or the power of 
reaction feeble, then the cold to the surface has 
a contrary effect, and does an immense amount of 
evil, for the internal organs remain congested, and 
there results an impairment of their functions. If 
after a cold bath the skin remains pallid, the lingers 
blue and cold, it indicates that the reaction is incom- 
plete, and that the effects are injurious ; or if, after 
reaction has taken place, there follow sensations of 
languor, headache, chilliness, or general weariness, it 
indicates that the cold bath is doing a positive harm 
and is too depressing ; in both of these cases bath- 
ing in tepid water should be substituted. 

During the winter months a bath two or three 



94 HYGIENE OF CHILDHOOD. 

times a week will be sufficient for a child from the 
age of three to ten years. The temperature of the 
water should be from 90° to 95° Fahr., and the bath 
should be given at night. Boys and girls of older 
years, who have robust constitutions and full, active 
circulation, may with benefit indulge in a daily 
sponging with cool water (temperature TO to 75° 
Fahr.), provided it is always done in a warm room ; 
but a child under ten years of age, or one who has 
heart or pulmonary trouble, whose circulation is 
feeble, or one who is of nervous temperament, or 
who is not in a robust condition of health, should 
never be permitted to enter a bath during the win- 
ter in water under 90° Fahr. or to be sponged off in 
very cold water. 

Children who enjoy and are benefited by their 
daily morning s|3onge-baths during the summer can 
not always carry it on with impunity during the 
autumn and winter ; for the vitality of many is so 
poor during the early hours of the day, that the 
sponge-bath, even with tepid water, at this time 
exerts such an enervating effect that the functions 
of digestion are partially arrested, the appetite for 
breakfast is apt to be blunted, and a lassitude which 
is attributed to other causes is induced. Daily 
sponging the feet with cold water, when followed 



CARE OF THE SKIK 95 

by brisk friction with a towel, can be borne by all 
children during the winter months, and is especially 
beneficial when they complain of cold feet ; spong- 
ing the throat and shoulders with cool water will 
also be beneficial and instrumental in warding off 
throat colds. 

During the summer months, on account of the 
increased activity of the cutaneous glands, a very 
much larger amount of deleterious matter is elimi- 
nated from the skin than during colder weather; 
the bath at this period becomes, therefore, a greater 
necessity. A daily sponge or full bath is not only 
productive of increased healthfulness, but is refresh- 
ing and adds to the comfort of the body. 

In giving a sponge-bath, the child should stand 
or sit in a tub, in which there is perhaps two or 
three inches of water, and be rapidly sponged ; this 
should be supplemented by moderately vigorous 
friction with a coarse towel until the skin is in a 
glow. 

I have frequently seen a rapid improvement in 
the health of a child by simply substituting a bath 
once a week for an accustomed daily bath, and order- 
ing the entire body to be vigorously rubbed with a 
coarse towel night and morning. The skin of many 
children, especially those who do not take much ex- 



96 HYGIENE OF CHILDHOOD. 

ercise, is so inactive during the winter months, that 
it fails to exercise its accustomed duty of elimina- 
tion. 

In such cases, vigorous rubbing stimulates the cir- 
culation, thereby increases the activity of the sweat- 
glands and opens their ducts, causing far greater 
"benefit than the daily sponging or bath. Rubbing 
the body rapidly with a coarse towel, that has been 
wet and wrung as dry as possible, is an admirable 
substitute, during cold weather, for the daily s}3onge- 
bath for children whose circulation is defective ; the 
necessary cleanliness is secured, and a delightful 
glow and a feeling of warmth are experienced. 

Salt water for bathing or sponging is extremely 
beneficial when the circulation is defective, and may 
be used two or three times a week with great advan- 
tage by children who perspire too freely, owing to 
weakness. The salt in the water is a stimulant to 
the relaxed cutaneous blood-vessels, and exerts a 
tonic effect upon the whole system. It is not neces- 
sary to go to the sea-shore to obtain the salt water, 
for it can be made in any household by mixing 
coarse salt or Ditman's sea salt with ordinary water. 
During the summer months, the health of many 
drooping children can be restored by the use of 
these tepid or cool " home sea-baths." 



CARE OF TEE SKIN. 97 

Early youth is not the period to attempt a hard- 
ening process. A protest has already been entered 
against the hardening by scanty clothing, and now 
my protest is offered against hardening by cold 
baths. Some children will come through the pro- 
cess successfully, and be held up as examples of the 
benefits of cold water, but the many unsuccessful, 
who will fall under the observation of the physician, 
are lost sight of. 

In the effort to avoid too cold baths, care must 
be taken that an error is not made of giving too hot 
baths, for it must be remembered that hot baths are 
as depressing as the cold baths are exhausting. 

The duration of the bath is also an important 
matter of consideration. A bath in cool water should 
never occupy longer than five minutes, and a full 
warm bath longer than ten minutes. If the child is 
permitted to remain longer in the water, more or less 
exhaustion will follow, which, if repeated daily, or 
several times a week, will result in an enfeebled con- 
dition of body. The bath in the ocean can often 
be extended to fifteen or twenty minutes if the surf 
is not too high. "While bathing in the ocean, the 
activity of the body and the splash of the water 
stimulate the circulation and prevent the depres- 
sion that would otherwise take place. The ocean 



98 HYGIENE OF CHILDHOOD. 

bath, while capable of restoring vigor and health to 
those who make proper use of it, is also a powerful 
agent for evil. The tonic effect of sea air and active 
country life, is too often done away with by the 
prolonged and too frequent sea-bathing. I could 
detail numerous cases of prostration directly induced 
by too free indulgence in the ocean bath; in some 
cases it has taken months to restore the health that 
has been impaired by the ocean baths. A child 
under fourteen should not be permitted to bathe in 
the ocean daily, nor should it be allowed to bathe 
when the temperature of the sea- water is under 70° 
Fahr. 

Wading or paddling in the sea-water is not 
always devoid of danger. Children are frequently 
permitted this indulgence before the water is warm 
enough for a full bath, and as a consequence of the 
direct heat of the sun upon the head and upper part 
of the body, and of the cold water about the feet and 
legs, there are often induced sharp intestinal disorder 
and congestion of the liver, and more or less dis- 
turbance of the nervous system, evinced by head- 
ache and restlessness at night. "With certain restric- 
tions, wading in the sea-water is naturally allowable, 
but parents must be on their guard that delicate 
children do not remain too long in the enjoyment 



CARE OF THE SEIK 99 

of this pleasure, and that it is not indulged in when 
the water is cold. 

The following quaint verses, published some 
time ago in England, by Mr. Joseph Power, bear so 
practically on this subject that they are here quoted 
in full : 

THE SKIN. 

There's a skin without and a skin within, 

A covering skin and a lining skin ; 

But the skin within is the skin without, 

Doubled inward, and carried completely throughout. 

The plate, the nostrils, the windpipe, and throat, 
Are all of them lined with this inner coat ; 
Which through every part is made to extend — 
Lungs, liver, and bowels — from end to end. 

The outside skin is a marvelous plan 

For excreting the dregs of man ; 

While the inner extracts from the food and the air 

What is needed the waste of the flesh to repair. 

Too much brandy, whisky, or gin, 
Is apt to disorder the skin within; 
While if dirty and dry, the skin without 
Refuses to let the sweat come out. 

Good people all, have a care of your skin, 
Both that without and that within ; 
To the first give plenty of water and soap ; 
To the last little else but water, we hope. . 

But always be very particular where 

You get your water, your food, and your air ; 



100 HYGIENE OF CHILDHOOD. 

For if these be tainted or rendered impure, 
It will have its effect on the blood, be sure. 

The food which will ever for you be the best 
Is that you like most and can soonest digest; 
All unripe fruit and decaying flesh 
Beware of, and fish that is not very fresh. 

Your water, transparent and pure as you think it, 
Had better be filtered and boiled ere you drink it ; 
Unless you know surely that nothing unsound 
Can have got to it over or under the ground. 

But of all things the most I would have you beware, 
Is breathing the poison of once-breathed air ; 
"When in bed, whether out, or at home you may be, 
Always open the windows and let it go free. 

"With clothing and exercise keep yourself warm, 
And change your clothes quickly if caught in a storm ; 
For a cold caught by chilling the outside skin, 
Flies at once to the delicate lining within. 

All you who thus kindly take care of your skin, 
And attend to its wants without and within, 
Need never of cholera feel any fears, 
And your skin may last you a hundred years. 



EDUCATION. 

It is generally admitted that insanity and various 
diseases of the nervous system have materially in- 
creased during the past decade. One prominent 
cause for this is the great strain imposed upon the 
nervous system by the demands of our present civili- 



EDUCATION. 101 

zation. The requirements necessary to success in 
life are now far greater than was the case a score of 
years ago ; and to meet this increased tax requires a 
vigorous physique and a healthy nervous system, the 
foundations of which must be laid during the years 
of growth. It is important, therefore, that the 
child's development should be carefully guarded 
from everything that will detract from the posses- 
sion of "mens sanain corpore sano." 

The nervous system, which controls and directs 
the working of the whole organism, must not be 
exhausted or overtaxed, for, when this occurs, all the 
functions of the body are more or less perverted in 
their action, and the full strength of nerve-force is 
frequently not regained. A parent's aim for his 
child during early youth should be that he may 
develop a healthy physique, rather than that he 
should obtain any amount of knowledge from books. 
The mental faculties should be allowed to develop 
slowly, as much as possible without stimulation, and 
the life should be more like that of a young animal. 
The early over-stimulation of the brain diverts the 
nerve-force from its most important duty of direct- 
ing the growth of the body. By committing to 
memory too many nursery rhymes the mind is over- 
taxed, and harmful results are sure to follow. Young 



102 HYGIENE OF CHILDHOOD. 

children are often made wakeful at night, have 
dreamy, startled sleep, and are unable to take the 
noonday nap, which is so important for them, simply 
because the brain has been over-stimulated and excit- 
ed by too much brain-work. Among the educated 
classes a child under six years of age will absorb 
ideas as rapidly as it is good for the brain, simply 
from association with older people. From the stories 
read aloud, and from the illustrated blocks and pict- 
ure-books that are now so abundantly supplied to the 
nursery they will often learn the alphabet and possi- 
bly begin to spell out a few words. 

The age at which a child should commence 
school duties opens a subject upon which there is a 
great diversity of opinion. The majority of physi- 
cians, and others who have made the hygiene of child- 
hood a study, are convinced that a child under six, and 
in many instances under seven years of age, should 
not be permitted regular lessons, or have school du- 
ties, and that from the age of seven to ten, the confine- 
ment in the school-room should never be longer 
than from three to three and a half hours daily. 
Sending the child to school " to be kept out of mis- 
chief " is a dangerous expedient. 

Kindergarten instruction is invaluable for chil- 
dren between the ages of four and seven years, and 



education: 103 

its advantages are being more and more appreciated 
by parents. By it, physical and mental education 
are carried on side by side, in such a manner that 
there is no over-stimulation of the nervous system, 
the powers of observation and reasoning are de- 
veloped, and the child is better equipped for the 
regular duties of school-life after the seventh year. 

The attention to hygiene, now more thoroughly 
understood, and the more intelligent care of infants 
and children, have lessened, to a very great extent, 
the mortality of the young. As a result, there now 
survives a very much larger percentage of children 
who are delicate by inheritance, than was the case 
during the early days of our ancestors. This 
inherited delicacy is too often not recognized, 
and the child undergoes the same mental and physi- 
cal regimen as children of stronger constitution, 
instead of being given time to mature more slowly 
and acquire a firmness of tissue and nerve strength, 
before the strain of school duties begins. It fre- 
quently happens that children who are delicate by in- 
heritance have unusually bright minds and are quick 
and eager to learn. Parents should be very guarded 
in these cases to curb the child's precocity, and 
should direct their attention, during early youth, to 
strengthening the body, in order that at maturity 



104 HYGIENE OF CHILDHOOD. 

the physical strength may permit the full enjoy- 
ment of mental activity. 

It should be carefully looted to that the hours 
for sleep and exercise, which I have already shown 
to be of great importance, are not drawn upon for 
study, otherwise physical degeneracy will follow as 
a result. The excessive demand of the brain for 
blood, which is always the case where there is over- 
study, deprives the other parts of the body of their 
share. Prolonged mental work induces more or 
less exhaustion of the nerve-force, thus depriving 
the nervous system of its ability to fulfil its mission 
of guiding and controlling the workings of the vari- 
ous organs of the body. The functions of digestion 
especially suffer from the faulty nerve-force, and 
this induces indigestion, and adds another cause of 
delicacy as the result of over-stimulation of mental 
powers. 

The question of mental training for the young 
is too broad a subject for me to enter upon in this 
compendium ; I merely wish to utter a few words 
of warning as to the danger of too early and forced 
instruction, some of the immediate effects of which 
are pallid countenance, frontal headache, puny, un- 
healthy looks, defective digestion, susceptibility to 
disease, feeble power of recuperating from illness, 



EDUCATION. 105 

and a fretful, irritable disposition. If the life of 
the child be spared, the future is liable to be blight- 
ed by a general want of strength, and by disorders 
caused by a defective nerve-force. 

If any of the symptoms enumerated appear 
while the child is attending school, it should be 
ascertained whether the hours for sleep and exercise 
are not drawn upon for study, and, if this be the 
case, the number of studies should be at once re- 
duced, or the child should be taken away from 
school for a time. 

In seeking the cause of the loss of vitality, par- 
ents must be just in their analysis of the child's 
habits. The tendency to place the onus upon over- 
study is very great, for unquestionably over-mental 
application is very often the cause ; more frequently, 
however, the failure in health is the result of a non- 
observance of hygienic laws. A child between ten 
and fifteen years of age, who takes a sufficient quan- 
tity of good nourishment, is properly clad, breathes 
a pure atmosphere, is compelled to take several 
hours' recreation daily, who secures from eight to 
ten hours' sound sleep every night, and is kept free 
from the excitement of theatres, concerts, and par- 
ties, runs little risk from mental application. 

Care must be taken that a child is not sent 



106 HYGIENE OF CHILDHOOD. 

back to school too soon after having been ill with 
typhoid fever, scarlet fever, diphtheria, pneumonia, 
or other diseases where there have been serious con- 
stitutional disturbances. This care should be more 
particularly observed with girls from the age of 
twelve to fifteen — during the years of puberty. 
Too early return to school duties after a serious ill- 
ness at this age, especially after typhoid fever, fre- 
quently will arrest the growth, and induce a delicacy 
which may take years to eradicate. The period of 
convalescence should be prolonged as much as pos- 
sible, to enable the nervous system, which is always 
exhausted by prolonged fever, to thoroughly recu- 
perate or regain the force lost during the illness. 

SCHOOL HYGIENE. 

The importance of school hygiene is too often 
overlooked by parents in their selection of a school. 
By school hygiene is meant the purity of the school- 
room air, its warmth, its cleanliness, its light, the san- 
itary surrounding of the play-ground, the duration 
of school hours and recess, and the suitability of 
the chairs and desks to the requirements of each 
child. 

The imperfect observance of these hygienic ne- 



SCHOOL HYGIENE. 107 

cessities frequently occasions the headache, the loss 
of appetite, the languor, the disinclination for walk- 
ing and exercise that many children experience on 
returning home from school. When the school- 
room is well lighted, the air pure and not over- 
heated, the habit of attention and power of applica- 
tion are very greatly increased. 

We have already explained the evils resulting 
from foul air in the house ; the same results natu- 
rally follow the breathing of foul school-room air, 
where its effects bring also demerits to the child, 
by blunting his intellectual faculties. Restlessness 
and forgetfulness, often the result of foul air, are 
punished by the extra hour of detention after the 
school hour proper. This additional strain, added 
to the loss of dinner — for by this time the appetite 
is usually destroyed — reacts upon the child, bringing 
on the morrow an increasing dullness. 

A wholesome and tempting lunch should be pre- 
pared, and the child should be given to understand 
that he must eat it, for continued mental work is 
more or less exhausting, and Nature calls for a res- 
toration of the tissues used up or destroyed by exer- 
cise. 

The desks and chairs should be so constructed 
that the book on the desk is not brought too near 



108 HYGIENE OF CHILDHOOD. 

the eyes of the scholar, nor should it be so low as to 
allow the child to bend the back while studying. 

The instructors should have such knowledge of 
physiology and personal hygiene that they may in- 
telligently enforce the laws of health so far as they 
relate to school-life. If this necessary knowledge 
were required of all teachers, there would be an in- 
crease in the average intelligence of the pupils, 
fewer absentees from school on account of illness ; 
and rounded shoulders and crooked spines, the re- 
sult of faulty positions at the school-desk, would be 
less frequently met with. 

DISCIPLINE. 

To enable a parent to carry out effectually the 
regulations necessary for the healthy growth of a 
child, it is essential that the child should be taught 
obedience and self-control. Lessons in obedience 
can be and should be commenced during the early 
months of infancy ; for children, like animals, will 
intuitively recognize the necessity of obedience and 
the authority and right to be commanded when the 
commands are given in a kindly yet positive manner. 
"When children rule their parents in matters of eat- 
ing or dressing, or in any equally important duty of 
life, there is less likelihood that the principles neces- 



DISCIPLINE. 109 

rary for the maintenance of health will be fully en- 
forced ; so that in the hygiene of childhood, the 
mainspring is discipline in obedience and self-con- 
trol. When this discipline is not enforced, when 
children are allowed to carry out their own ideas, to 
gratify their own wishes, and are not taught defer- 
ence for the authority and opinion of their elders, 
they are apt to grow up selfish, and to exert an un- 
pleasant influence upon those about them. 

Unfortunately, many parents have not the ability 
to teach their children the habit of self-control, on 
account of possessing so little of it themselves, and 
children, from force of example, become self-indul- 
gent. Then, too, when obedience is exacted, harsh- 
ness, almost brutality, is often employed, instead of 
that firm but kindly insistence which calls forth a 
more cheerful acquiescence upon the part of the child. 
It is impossible to expend too much effort in form- 
ing the habit of self-control. When this is not cul- 
tivated, the child becomes a monster of selfishness, 
and a source of continual discomfort to himself and 
those about him; while, on the other hand, the culti- 
vation of self-control insures a happier disposition, 
which will win friends in later years and also in- 
crease the prospect of prolonged life and vigorous 
health, making him a more evenly balanced man, 



110 HYGIENE OF CHILDHOOD. 

and widening his field of usefulness in the commu- 
nity in which he lives. In enforcing obedience, 
harsh terms are not necessary. A child, by nature, 
has an inquiring mind, and desires to know the 
causes of everything. While obedient, the reason of 
an order will frequently be asked; this should be 
gratified when feasible. At the same time, the child 
should be taught to have such confidence in his 
parents that he will understand, when a command is 
given, that it must be obeyed, even though the pur- 
port is not understood. Whenever it is proper to 
give the reason for a request, it is well to do so, 
for a child's ideas are thus educated, a habit of 
reasoning is developed, which is always important 
for the young mind, while at the same time it fos- 
ters a closer relationship between the parent and 
child. 

The physician, on his round of visits among the 
sick, is only too familiar with the unfortunate, often 
disastrous results of want of self-control. How fre- 
quently the reply, when the doctor prescribes a 
certain diet or a certain mode of exercise, " Well, 
doctor, the child would have it," or " The child ob- 
jected to doing as you said " ! The little tyrant 
must be obeyed ; the parents must comply with his 
wishes, even though the judgment decides against it. 



HYGIENIC REFLECTIONS. Ill 

"With such children and parents the laws of health 
can not be judiciously followed. The child that 
makes free use of the words "shall," "won't," 
" sha'n't," or " will " has a diminished chance of re- 
covering from serious illness. 

These demonstrations of self-will are not so much 
the results of rebellion and temper as they are of 
faulty management during the early years of life 
upon the part of the parent. Recognizing the fact 
that children's dispositions differ in many cases, the 
seeming irritablity may often be overcome by firm- 
ness, kindness, and explanation. It should not be for- 
gotten, however, that the irritability of many chil- 
dren, and their disobedience, which is frequently de- 
pendent upon a condition of irritation, are also occa- 
sionally the results of impaired health. "We see, 
then, how defective physical condition in a child 
disturbs calmness of disposition, and how the ab- 
sence of self-control affects the physical health. 

HYGIENIC KEFLECTIONS. 

During childhood the seeds of future health, 
vigor, and, I might add, happiness, are sown. " As 
we sow, so shall we reap." As Dr. Erasmus Wilson 
has very fitly remarked : " Youth, it can not be too 



112 HYGIENE OF CHILDHOOD. 

often repeated, is the time for storing health, both 
physical and moral ; and every act which can in any 
way impede or frustrate this all- wise intention of 
Nature will tend to lay the foundation of a weak 
and imperfect body, and shorten the days of its pos- 
sessor." The laws of health are as fixed as other 
physical laws, and any infringement of them is cer- 
tain to be followed by evil results ; so that if the 
body is not properly clad, if there is insufficient or 
improper nourishment, a deprivation of sleep, exer- 
cise, pure air, or sunshine, if the brain is overtaxed 
with studies, or if any of the laws governing health 
are violated during childhood, a penalty will be ex- 
acted — if not during the period of youth, certainly 
later in lif e. 

Herbert Spencer says of children : " To tens of 
thousands that are killed, add hundreds of thousands 
that survive with feeble constitutions, and millions 
that grow up with constitutions not so strong as 
they should be, and you will have some idea of the 
curse inflicted on their offspring by parents igno- 
rant of the laws of health. Do but consider for a 
moment that the regimen to which children are sub- 
ject is hourly telling upon them to their life-long 
injury or benefit, and that there are twenty ways 
of doing wrong to one way of doing right, and you 



HYGIENIC REFLECTIONS. 113 

will get some idea of the enormous mischief that is 
almost everywhere inflicted by the thoughtless, hap- 
hazard system in common use. Is it decided that 
a boy shall be clothed in some flimsy short dress and 
be allowed to go playing about with limbs reddened 
by cold ? The decision will tell on his whole future 
existence, either in illnesses, or in stunted growth, 
or in deficient energy, or in a maturity less vig- 
orous than it ought to have been, and consequently 
be a hindrance to success and happiness ! Are chil- 
dren doomed to a monotonous dietary, or a die- 
tary that is deficient in nutritiveness ? Their ulti- 
mate physical power and efficiency as men and wom- 
en will inevitably be more or less diminished by 
it. When sons and daughters grow up sickly and 
feeble, parents commonly regard the event as a mis- 
fortune, as a visitation of Providence. Thinking 
after the prevalent chaotic fashion, they assume that 
these evils come without causes, or that the causes 
are supernatural. Nothing of the kind ! In some 
cases the causes are doubtlessly inherited ; but in 
most cases foolish regulations are the causes. Yery 
generally parents themselves are responsible for all 
this pain, this debility, this depression, this misery. 
They have undertaken to control the lives of their 
offspring from hour to hour; with cruel carelessness 



114 EYGIENE OF CHILDHOOD. 

they have neglected to learn anything about those 
vital processes, which they are unceasingly affecting 
by their commands and prohibitions ; in utter igno- 
rance of the simplest physiological laws, they have 
been year by year undermining the constitutions of 
their children, and have so inflicted disease and pre- 
mature death not only on them, but on their descend- 
ants." 

If a child manifests any bodily weakness that is 
not hereditary or that has not followed some acute 
illness, parents should ask themselves the question, 
Which of the laws of health has been violated? If 
careful scrutiny is given, it will be found that the 
impaired health has been induced by one or more of 
the following causes : Insufficient or improper nour- 
ishment, irregular or too hasty eating, whereby the 
functions of digestion are disturbed, and the power 
of assimilation of food impaired ; drinking impure 
water, a prolific cause of lowering the tone of the 
system and bringing about mal-digestion ; breathing 
impure air ; insufficient sunlight ; insufficient exer- 
cise in the open air ; insufficient protection of the 
surface of the body, the non-wearing of flannels by 
night as well as by day during the winter months ; 
insufficient sleep and repose ; neglecting the daily 
action of the bowels and care of the skin ; overtax- 



PUBERTY. 115 

ing the nerve-force by too mnch memorizing and 
overstudy. 

The symptoms indicating a lowered vitality often 
come on so insidiously that they are overlooked by 
the parent until the health is seriously undermined. 
These symptoms may be briefly stated as follows : A 
change in the general demeanor, a depression with 
loss of the usual brightness and vivacity, often dull- 
ness and languor, or irritability, when the child is 
said to be " cross," sleeplessness, or a disturbed, rest- 
less sleep, frequently a tendency to fall asleep during 
the daytime, loss of flesh, pallid countenance, and 
disinclination to take the accustomed exercise. 

Many hereditary physical tendencies may be over- 
come by special attention to the child's personal hy- 
giene. 

PUBERTY. 

My remarks on the preceding pages apply alike 
to the boy and girl. I now desire to call special at- 
tention to the hygiene of the girl, daring that pe- 
riod of transition from girlhood to womanhood, 
termed puberty, a time when too often, through neg- 
lect, the seeds of future ill health are sown. 

A case in point will serve as a text for this im- 
portant subject. I was once called to see a young 
girl of about fourteen years of age, who, from a state 



116 HYGIENE OF CHILDHOOD. 

of apparent health, was suddenly prostrated while at 
a child's party. She was taken home and remained 
in a condition of exhaustion for several weeks. Pos- 
sessing an active temperament, she had always been 
quick and eager to learn. Her studies had been con- 
tinued without intermission, save for a few school 
holidays, summer and winter, during the period of 
two years. This unnatural strain gave the system 
no rest, it burned up the nerve-force as rapidly as it 
was created. The overheated room at the entertain- 
ment had a depressing effect upon her, snapped the 
tension to which the nervous system had been sub- 
jected, and induced a condition of physical and 
nerve exhaustion. This depression was character- 
ized by great feebleness of the digestive organs, a 
condition of torpidity, irregular heart-action, head- 
ache, great lassitude, but no fever. She remained in 
this condition for several weeks, gradually recover- 
ing her strength, but showing for many subsequent 
months an appearance of weariness in her counte- 
nance. It was necessary to abandon her studies for 
more than a year ; and for several months after they 
were resumed, only light mental work was possible. 
The early history of this young girl is but a rep- 
etition of many others which are constantly brought 
to the notice of physicians, where the education of 



PUBERTY. 117 

the mind is at the expense of the body ; where, at the 
period of life when the nervous structure is develop- 
ing, when the reproductive organs are taking on 
new changes, the nerve-force is exhausted by over- 
stimulation of the brain and does not obtain suffi- 
cient rest. 

The question is often asked, "Why is it that 
young children and girls of the present time can not 
dress and do as did their mothers and grandmothers 
at their age ? Excepting when there is hereditary 
delicacy, girls of the present generation will be found 
just as robust and just as capable of enduring strong 
physical exercise as their grandmothers were, always 
providing that their lives are adjusted in conform- 
ity with the laws governing health. Degenerated 
health is in most cases the result of exhausted nerve 
energy, improper diet, and an inactive, indoor life. 

Let us contrast for a moment the life of the pres- 
ent generation with that of three generations ago. 
Our grandparents were, in a measure, " the survival 
of the fittest." Their manner of living was such 
that the majority of delicate offspring perished in 
early life ; and those who survived, and whose consti- 
tutions withstood the strain, were the possessors of a 
vigorous physique. Mothers must disabuse their 
minds of the common error that because they and 



118 HYGIENE OF CHILDHOOD. 

their mothers dressed, or rather undressed, in accord- 
ance with the fashion of their day, they may continue 
to clothe their children in the same way. In cases 
where bare legs, arms, and neck were adopted, evil 
results must have followed, and fallen, if not upon 
the individual herself, certainly upon her offspring, 
for the laws governing health were the same then as 
they are now. Those who are vigorous and strong 
can resist an evil influence longer than those who 
are weak. 

We at present live in an essentially fast age. 
Our parents and grandparents lived a quieter life. 
There was then an absence of many of the excite- 
ments which call into action the nerve-force of the 
present generation. The rush and excitement that 
our every-day life call for, did not exist three quar- 
ters of a century ago, and consequently the tax upon 
the mind, and the wear and tear on the nerve-force, 
of both young and old, were not so great then as now. 
The home life of the present generation is, as a rule, 
full of ceaseless activity. The sensational events that 
the newspapers recount, reach the various homes, are 
too often discussed before children, and can not but 
have a stimulating effect upon their brains. The 
school-books of to-day, although in many respects 
most suitable, call for an amount of close applica- 



PUBERTY. 119 

tion and an exercise of thought that were not re- 
quired of our grandparents. 

The life of a century ago was comparatively a 
quieter one and less conducive to nerve exhaustion. 
Books were of a less stimulating character ; the daily 
papers did not introduce into the family circle topics 
of such an exciting nature ; there was an absence of 
the hurry and rush of modern travel and business. 
In other words, the life of to-day is productive of 
nerve excitability, to be followed by exhaustion, 
while the life of olden days was more favorable to 
nerve rest. 

This comparison of the life of our grandparents 
with the life of the present generation is brought 
forward to show that in this era there is an increased 
call for nerve energy and the greatest danger of ex- 
hausted nerve-force, and emphasizes the importance 
for mothers arid guardians of the young, to watch 
and guard carefully the nervous and physical condi- 
tion of young girls as they bloom into womanhood. 

The good book says that the sins of the fathers 
shall be visited upon the children unto the third and 
fourth generation. This is perfectly true of physi- 
cal as well as of moral sins. How often do we 
see handsome, stately mothers and grandmothers of 
seventy or eighty years af age, with clear eyes, fine 



120 HYGIENE OF CHILDHOOD. 

complexion, erect carriage, and every appearance ol 
good health, surrounded by children and grandchil- 
dren of delicate constitutions ! This feebleness is not 
entirely due to the follies of the present manner of 
living, but may be largely due to the erroneous life of 
the mother or grandmother, who as " survival of the 
fittest " apparently grew physically and mentally to 
perfection, yet her fruit suffered from the result of 
her indiscretion. If this truth is fully recognized 
and borne in mind during the period of a young 
girl's development, there will be a distinct gain, not 
only to her in the possession of a healthy body and 
mind, but also to her future offspring. A tree in 
the orchard may recover from the shock of a cold 
spring, be rich in foliage and have a stately appear- 
ance during the summer, yet not be so productive in 
the quantity and quality of its fruit as a tree that 
has had no shock. 

Aside from the suggestions already given for the 
care of children, there are a few fundamental rules 
to be observed by young girls at this time, the neg- 
lect of which only too frequently inflicts pain and 
suffering on body and mind in after-years. As the 
young girl approaches this time of life, a change 
is noticed in her demeanor and general habits. 
There is frequently a derangement of digestion ; the 



PUBERTY. 121 

appetite is capricious and morbid ; there may be de- 
pression of spirits, languor, a certain amount of men- 
tal inactivity, and at times a restlessness and irrita- 
bility of an hysterical nature. The child's mind 
should be prepared for the coming change. The 
mother should, by a few judicious words, put clearly 
before her daughter the nature of the coming event, 
and explain the necessity of careful obedience to the 
rules given her for the care of her health at this 
time. The great change that is going on in the 
system produces a disturbance in the circulation ; 
this affects the appetite, and occasions the symptoms 
above mentioned. Disturbances of all kinds should 
be promptly investigated and relieved, in order that 
the child may be kept as nearly as possible in a per- 
fect state of health, and that all stumbling-blocks 
may be removed from Nature's way in this crisis she 
is bringing about The digestion should be kept in 
perfect order, the bowels regular, and morbid crav- 
ings should not be indulged. Food should be of a 
simple, non-stimulating character. If there is any 
languor or debility, it should be met by tonics, 
plenty of fresh air, and good food. The depression 
of spirits or irritability may be relieved by regulat- 
ing the digestion, by tonics, by release from all men- 
tal work, and by the society of cheerful companions. 



122 HYGIENE OF CHILD HOOD. 

I have called attention to the importance of pro- 
tecting the body from cold ; the directions given ap- 
ply now with double force. In the climate in which 
we live it is absolutely necessary that the body of 
every individual should, in winter, be protected by 
flannel or silk worn next to the skin. When this is 
neglected, there is a great waste of nerve-force in 
Nature's effort to maintain the proper standard of 
animal heat. Extreme care should be paid to the pro- 
tection of the feet. The reader is doubtless aware 
of the disastrous effect of a cold foot-bath during 
the monthly period ; a severe congestion takes place 
in the pelvic region, followed frequently by inflam- 
mation and death. When the feet are constantly 
bathed in cold air, as they are when slippers are worn 
in the house in cold weather, and thin shoes in the 
street in winter, we have resulting more or less con- 
gestion, or oversupply of blood to the pelvic organs. 
Oftentimes this congestion is so slight that its pres- 
ence is not apparent. If, however, it is maintained 
for any length of time, structural changes take place, 
and create the pain and distress that so many girls 
and women undergo. If any one organ of the 
body is already in a state of congestion, this conges- 
tion will be increased by cold to the extremities, 
We now see the importance of protecting the feet 



PUBERTY. 123 

and legs of the young girl when this change in her 
system is taking place. At this time the pelvic or- 
gans are in a condition of increased nervous irritabil- 
ity, a natural, healthy state of congestion ; but if we 
have thrown upon them an abnormal congestion, 
disease is the result. Therefore, one of the first rules 
for young girls, and I should add women also, to ob- 
serve, is to protect the feet, not only during the men- 
strual period but at all times. When the physician 
urges the necessity of flannels being worn next the 
skin, both undershirt and drawers, and of protecting 
the feet by warm boots, and the avoidance of slip- 
pers in winter, many will use the argument that they 
are well and strong, and point to others who are also 
strong notwithstanding improper dressing. This is 
very poor reasoning : one may not realize the conse- 
quence of a wrong deed, but that does not make the 
deed right. Many who are insufficiently clad may 
say that they do not feel cold. This may be true, 
for the surface of the body and feet may cease to be 
conscious of cold, from habitual exposure, just as we 
cease to be conscious that our faces are cold, even 
when out-of-doors ; but, because the sensation of cold 
no longer warns us, it does not follow that the sys- 
tem escapes injury. Thousands and tens of thou- 
sands die in their effort to follow the example 



124 HYGIENE OF CHILDHOOD. 

of those foolhardy people who defy the laws of 
Nature. 

Another important matter to observe at this 
time is the avoidance of too great mental strain. It 
must be remembered that the nervous system is 
called upon to perform a new duty ; extra work is 
required of it, and one must be watchful that it is 
not overburdened. For several months before the 
establishment of menstruation, and during the first 
year of the change, school duties should be very 
light and at times omitted, if any symptoms indi- 
cating marked nerve disturbance supervene. This 
nerve disturbance is shown by restlessness or head- 
ache, excitability, irritability of temper, or by an 
hysterical condition, when the young girl cries with- 
out cause, or from a cause which, at other times, 
would have no effect upon her. If there are pallor 
of countenance, weariness, and loss of appetite 
which is not improved by tonics, school duties 
should be omitted for a time, and exercise in the 
fresh air substituted. 

Sleep is one of Nature's greatest restorers ; par- 
ents can not be too particular, therefore, that at this 
time especially the young girl obtains her full amount 
of sleep for nine or ten hours. The disastrous ef- 
fects of overtaxing the brain at this time of develop- 



PUBERTY. 125 

merit, often follow one through the remaining years 
of life ; the periodical sick headache, to which so 
many women are martyrs, is, in many instances, 
entirely the result of an overtaxed brain at the time 
of puberty. The nervous system of a girl is more 
highly organized, more sensitive to impressions, and 
therefore needs more rest and protection, than that 
of a boy. Her organs of generation require the full 
amount of nerve-nutrition for their perfect devel- 
opment. When the nerve-force is diverted by too 
great mental strain, or by repeated shocks to the 
system from cold, as the result of scanty clothing, 
an arrested development of the ovaries and uterus 
is very apt to occur, and after marriage there is a 
strong likelihood of a childless home. 

Mental work should be relaxed, and in many 
cases entirely given up, during the few days of men- 
strual activity. " Nature has reserved the catame- 
nial week for the process of ovulation, and for the 
development and perfection of the reproductive sys- 
tem. Previous to the age of eighteen or twenty, 
opportunity must be periodically allowed for the 
accomplishment of this task. Both muscular and 
brain labor must be remitted enough to yield suf- 
ficient forces for the work. If the reproductive 
machinery is not manufactured then, it will not be 



126 HYGIENE OF CHILDHOOD. 

later. If it is imperfectly made then, it can only be 
patched up, not be made perfect, afterward. To be 
well made it must be carefully managed." * 

It is impossible to prescribe the amount of study 
that a young girl may safely undergo. We must 
base our determination of this question of mental 
work upon certain tangible facts or conditions. If 
there is any impairment of the general health or any 
irregularity of the menstrual functions, the amount 
of study should be curtailed, or interdicted alto- 
gether. 

If there is a hysterical or emotional tendency, it 
is an indication of a marked lowering of the nerve- 
force and an unbalanced nervous system. The girl 
should be taken from school; and exercise in the 
open air, with early hours for going to bed, should 
be ordered. If this emotional or hysterical condi- 
tion is not promptly checked during the years of 
puberty, it will be fostered and will grow as the 
burden of school duties increases, and in all proba- 
bility result in a complete collapse of health after 
leaving school or after marriage. 

There is a phrase, common in some families, that 
is calculated to mislead and do great harm by the 
careless and apologetic manner with which it is 

* "Sex in Education," by Edward II. Clark, M. D., p. 41. 



PUBERTY. < 127 

uttered. The daughter is said to be " so nervous " 
that " she can not be thwarted in her wishes." 
"Nervousness," which should rather read "nerve- 
lessness," is synonymous with irritability, and is a 
condition that should warn mothers of impending 
danger. The nerves are crying out that their power 
of resistance has departed. A state of nervousness 
is not natural to any girl, and, where it exists, it is a 
sure indication either that the nervous system has 
been overtaxed in some way, or that it is being irri- 
tated by some morbid condition, or that the body is 
not supplied with blood rich enough to furnish suf- 
ficient nourishment to the nervous system. This 
state of nerve-irritability should not be met with the 
amount of condemnation that it so often receives, 
but should be carefully studied ; the cause, when 
found, removed without delay, and every aid to the 
re-establishment of health should be afforded. 

In the management of girls of an hysterical or 
nervous temperament, a seemingly undue attention 
should be carefully avoided, lest it should aronse a 
craving for sympathy which leads to a condition of 
quasi-invalidism. The two extremes — that is, one of 
neglect or one of exaggerated care — are constantly 
met with, and both are equally reprehensible. 

I have already explained the systemic disturb- 



128 HYGIENE OF CHILDHOOD. 

ance arising when there is not a daily action from 
the bowels. During puberty, the evil resulting from 
failure to form this habit is very great, for we have, 
in addition to the systemie disturbance, a pressure 
upon the blood-vessels and nerves in the pelvic re- 
gions, which interferes with the circulation and with 
the healthy growth of the tissues in these parts, and 
is often the direct cause of pain and distress at the 
monthly period. 

Dr. Thomas Addis Emmet, in speaking of young 
girls during puberty, says : " To enable her to reach 
the highest physical development, the young girl, 
in the better class of society, should pass the year 
before puberty, and some two years afterward, free 
from all exciting influences. She should be a child 
as long as possible, and made to associate with chil- 
dren. Her dress, diet, and habits of life should be 
carefully looked after, as if she were a child, and, 
above all, the habit of regularity should be enforced 
in all details. Her mind should be occupied by a 
very moderate amount of study, with frequent in- 
tervals during school hours of a few moments each, 
and to be spent, when possible, in the open air. 
There should be no studying at night under any cir- 
cumstances. Each menstrual period should be passed 
in the recumbent posture, until the system becomes 



PUBERTY. 129 

accustomed to the new order of things, and the habit 
of regularity is fully established. She should neither 
expose herself to cold nor overexercise during the 
twenty-four hours before the expected period, and 
at the same time lessons should be discontinued." * 

During the later years of girlhood, as near an 
approach as is possible to mental and physical rest 
should be observed during the few days of indispo- 
sition each month. Long walks, running rapidly up 
and down stairs, dancing, skating, too prolonged 
standing, practicing on the piano, or any strong 
physical exercise, should be forbidden, and severe 
mental strain should be avoided. The want of suffi- 
cient rest during these few days is a prolific cause 
of the pelvic pains which are so prevalent among 
young women. Most of the uterine disorders that 
young girls are troubled with are induced by per- 
sonal neglect during the catamenia. The beginning 
of trouble may frequently be traced to a long walk, 
or skating, dancing, or wetting the feet at the men- 
strual period. This overexercise and cold to the 
feet transform a naturally healthy congestion of the 
pelvic organs into a morbid congestion, which re- 
mains after the few days of functional activity is 
over, and is the beginning of the suffering and de- 

* "Principles and Fractice of Gynaecology," p. 21. 



130 HYGIENE OF CHILDHOOD. 

rangement that affect, through reflex influence, the 
healthy working of other parts of the body. 

Although due care regarding sponging and bath- 
ing the body during the catamenia is generally ob- 
served, indiscretions are not infrequently met with. 
When a child has been accustomed to a daily cold 
bath, the necessity for omitting it, as well as the 
full warm bath at this time, should appeal to 
every reasonable person. Sponging certain parts 
of the body with tepid water, for the purpose of 
cleanliness, is permissible, but even this should be 
done with care, and in a warm room, for a chill to 
the skin during these important days is attended 
with more or less serious consequences. The luxury 
and comfort of a fall bath after several days' absti- 
nence frequently lead to the taking a cold, full, or 
ocean bath on the day immediately following the 
cessation of the period. This should never be per- 
mitted. At least thirty-six or forty-eight hours 
should elapse before a full cold bath, for the pelvic 
organs remain in a state of congestion for some time 
after the cessation of the menstrual flow. A tepid 
or full warm bath (not too hot) is permissible and 
gives comfort. 

Another cause creating pelvic trouble, aside from 
physical imprudences and wasted nerve-force, is 



PUBERTY. 131 

that of tight lacing. The compression that a tightly 
laced corset produces about the waist disturbs the 
abdominal and pelvic circulation, crowds the pelvic 
organs downward, causes misplacement, and retards 
the recovery from uterine congestion. 

"When a sufficient time has elapsed to show that 
the catamenia is fully and regularly established, a 
girl who is healthy and strong, and free from any 
suspicion of pelvic difficulty, may pursue her daily 
vocations during the monthly period. A slight 
amount of walking is conducive to the healthy ac- 
tion of the liver, to proper performance of the digest- 
ive functions, to the daily action of the bowels, and 
to a free circulation in the skin ; but unnecessary 
standing, heavy lifting, and undue activity must be 
avoided. When there is any form of pelvic trouble, 
however slight, rest must be enforced as much as 
possible. 

It is evident that nature never intended that 
woman should be entirely incapacitated for a period 
of from four to six days every month. But the physi- 
cal degeneration that is brought about through many 
and constant transgressions of the laws of health, 
and through hereditary defects, calls for a greater 
care of the person during these important days. 
This applies more to girls in the upper walks of life ; 



132 HYGIENE OF CHILDHOOD. 

for in this class indolent luxury, and obedience 
to the dictates of fashion, bring about the greatest 
number of cases of physical degeneracy. 

Although my remarks on the hygiene of child- 
hood are chiefly intended for the guidance of very 
young children, and of girls during the establish- 
ment of catamenia, most of the suggestions are equal- 
ly important and applicable, during the later years 
of development, until maturity has been reached. 
As the young girl advances in her " teens " her 
thoughts turn to social pleasures or to personal 
adornments. She will often assert and exercise her 
own judgment in matters pertaining to health, and 
in doing so will, through ignorance or vanity, in- 
fringe upon the laws of health and bring upon her- 
self sorrow and suffering during the years to come. 
This latter period is also an important one, and re- 
quires the same close attention to the protection 
of the body, sufficient sleep, exercise, sunshine, and 
proper nourishment, that we have already shown to 
be necessary for younger girls. 

The following example is but too often the repe- 
tition of the life of many a young girl of from fif- 
teen to eighteen years of age : Her studies are nu- 
merous and difficult, and call for close application, 
often both afternoon and evening being devoted to 



PUBERTY. 133 

them. She goes to bed exhausted, awakes in the 
morning with a feeling of languor, without appe- 
tite, frequently with headache and nausea. She 
can not eat any breakfast, and will start for school 
after taking a cup of coffee or tea and, perhaps, 
some slight article of food. She remains in school 
until two o'clock, taking during recess some indi- 
gestible lunch procured from the baker, and returns 
home in the afternoon with impaired appetite, and 
too tired to take more than a short walk. When- 
ever it is noticed that a young person eats little at 
breakfast, feels languid in the morning, and is too 
tired to take a brisk walk in the afternoon, it is an 
indication that something is radically wrong, and it 
is highly important that medical advice should be 
sought. When this is obtained, it is found, in the 
vast majority of cases, that other factors besides 
studies enter into the cause of the ill-health. 

Untold mischief results from the practice com- 
mon with many a school-girl of hurrying off to 
school either without breakfast or after having has- 
tily swallowed her food. The system, deprived of 
this needed support, is utterly unprepared to meet 
the demands upon its endurance for four or five 
hours of steady application. If every parent would 
establish the rule that a child should not be permit- 



134 HYGIENE OF CHILDHOOD. 

ted to go to school in the morning without having 
leisurely eaten a substantial breakfast, it would ma- 
terially add to the healthf ulness of the child, and di- 
minish the evil results of close application to study. 

The physician often finds, however, a difficulty 
in enforcing the directions given for a proper regi- 
men of diet suitable for a young girl in her " teens," 
for the commandment, " Children, obey your par- 
ents," is in many families reversed, reading, " Par- 
ents, obey your children," and the young girl follows 
her own ideas as to what and when she shall eat. 

At this age, social entertainments are not infre- 
quently the direct cause of impaired health and 
strength. The too frequent attendance upon par- 
ties, sociables, concerts, and the theatre during school- 
days means a deprivation of a certain amount of 
sleep, extra fatigue, the breathing of impure air, 
and, above all, the nerve- exhaustion from the excite- 
ment. School duties require all the nerve-force 
that can be spared from the building process which 
is still going on in the system, so that the combina- 
tion of undue social excitement with difficult les- 
sons has a damaging effect upon the health. A ju- 
dicious mother will not allow this combination, but 
it is altogether of too frequent occurrence in many 
homes. 



PUBERTY. 135 

A full amount of sleep, and exercise in the open 
air, should be insisted upon during this important 
period of life, and great care should be observed 
that the hours set apart for these essential requi- 
sites for health are not encroached upon for study 
and social pleasures. 

Physicians are constantly consulted by parents 
who say that their daughters' health is being under- 
mined by school duties. There is frequently a good 
deal of truth in the statement that they are study- 
ing beyond their years ; but we also find, only too 
frequently, that the mother is ignorant of the laws 
of health, and that, through this ignorance, she is not 
doing her duty to her child. She is often responsi- 
ble for her daughter's ill-health by permitting her 
to sit up too late at night, attending parties and 
concerts, by allowing her to wear thin boots and 
unsuitable underclothing, by not insisting upon suf- 
ficient nourishment, and by permitting too much 
exercise at the monthly period. With careful atten- 
tion to personal hygiene, and avoidance of an excess 
of excitement and of a too luxurious life, the mother 
will find that her daughter will be capable of great- 
er mental work, and that the school duties will not 
so often be incompatible with vigorous health. 

The culture of the body should be as much an 



13G HYGIENE OF CHILDHOOD. 

object of a mother's solicitude as that of the mind. 
As she recognizes the responsibility and necessity 
of cultivating the mental and moral qualities of her 
daughter, so should she feel that there is an equal 
obligation to cultivate a perfect physique. She 
should seek to inform herself upon the ways and 
means of preserving the health of her daughter, and 
make it an all-important object — I might say, a 
religious duty — to avoid everything which may 
prove an obstacle to the development of a perfect 
woman. 

" If we would give our girls a fair chance, and 
see them become and do their best by reaching after 
and attaining an ideal beauty and power, which 
shall be a crown of glory and a tower of strength to 
the republic, we must look after their complete de- 
velopment as women. Wherein they are men, they 
should be educated as men; wherein they are wo- 
men, they should be educated as women. The phys- 
iological motto is, educate a man for manhood, a 
woman for womanhood, both for humanity. In 
this lies the hope of the race." * 

* "Sex in Education," by E. H. Clark, H. D., p. 19. 



APPENDIX. 



MOETUAEY STATISTICS. 

It may not be without interest, as bearing upon 
the subject of the hygiene of childhood, to glance at 
the mortuary tables of some of the large cities of the 
United States, and also to note the comparative mor- 
tality of large and small cities. Upon investigation 
it will be found that during the past twenty years a 
gradual lowering of the death-rate among children 
has taken place, and that the percentage of deaths is 
noticeably less in the smaller cities. 

In New York city in 1867 the percentage of 
deaths among children under five years of age to 
the total mortality was 52'9 ; while in 1888, twenty- 
one years later, the percentage was 43-2, a lowering 
of 9.7 per cent, or an equivalent to saving in 1888 
the lives of 3,896 children under five years of age. 
From 1865 to 1875 the average mortality under 
five years of age in New York city was 49-61 
per cent. 



138 



HYGIENE OF CHILDHOOD. 



Mortuary Table for 1873. 



LOCALITY. 



New York city . . 
Philadelphia, Pa. 
Brooklyn, N. Y.. 

Chicago, 111 

St. Louis, Mo . . . 
Boston, Mass . . 
Baltimore, Md.. . 



Total 
Total number of 

number [ deaths under 
of deaths. five years 



29,084 
15,224 
10,968 
9,557 
8,551 
7,869 
7,817 



14,182 
6,260 
5,536 
5,676 
4,014 
3,289 



Percentage of 

deaths under 

five years of 

age to total 

mortality. 



Average mortality under five years of age for 1873, 47'4 



per cent. 



Mortuary Table for 1S88. 



LOCALITY. 


Total 
number 
of deaths. 


Total 

number of 

deaths under 

five years 

of age. 


Percentage of 
deaths under 
five years of 
age to total 
mortality. 




40,175 
20,372 
18,061 
16,645 
10,179 
9,015 
8,936 


17,360 
7,268 
8,019 
7,533 
3,599 
3,659 
3,881 


43-2 


Philadelphia, Pa 


35-6 


Brooklyn, N. Y 


44-3 




45 2 




35-2 




40-5 




43-6 







Average mortality under five years of age in 18SS, 41 per cent. 



A comparison of the average death-rate in 1873 
(474 per cent) with that of 1888 (41-0 per cent) 
exhibits a reduction of 6-4 per cent, or the saving 
of the lives of 7,896 children in the above-mentioned 
cities in 1888. 



APPENDIX. 



139 



Percentage of Deaths of Children under Five Tears of Age 
to the Total Mortality in Seven Cities of Small Size. 

Poughkeepsie, N. Y., in 18S8 32 "6 

Newburgh, N. Y., in 18S8 34"4 

New Haven, Conn., in 1888 34" 1 

Hartford, Conn., in 1888 27 '8 

Newport, R. I., in 1S88 31*4 

Lynn, Mass., in 1888 33-4 

Portland, Me., in 1888 22-4 

Average mortality under five years of age in 1888, 30'8 per cent. 

Table of Deaths in the United States according to the 
Census. 



TEAK. 


Total 
numher 
of deaths. 


Total 

number of 

deaths under 

five years 

of age. 


Percentage of 
deaths under 
five years of 
age to total 
mortality. 


1870 


493,263 
756,893 


203,213 

302,624 


41-4 


1880 


39-9 







A review of the above tables conveys an instruct- 
ive and forcible lesson upon the beneficial observ- 
ances of the laws of health — especially so, when it is 
understood that the lowering of the death-rate in the 
large cities during the past sixteen years has been 
coincident with increased interest in sanitation 
and the surveillance on the part of local boards of 
health over the habitations of the poor and of public 
buildings, as well as their watchfulness in prevent- 
ing in a great measure the sale of unwholesome 
food. 

The causes for the difference in the death-rate of 



140 HYGIENE OF CHILDHOOD. 

children, in large and small cities, lie in the facts 
that in small cities the inhabitants breathe a purer air, 
they are not so crowded together, their food is of 
better quality, their nervous system is not so exhaust- 
ed from excitement, and their whole conditions of 
life are more favorable to health. 

These considerations are powerful inducements 
for still greater attention to sanitary reform and the 
hygiene of childhood. 



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